Provider Demographics
NPI:1093350126
Name:POND, LORRIE A (LPN)
Entity Type:Individual
Prefix:
First Name:LORRIE
Middle Name:A
Last Name:POND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 COLLEGE HTS APT 2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1846
Mailing Address - Country:US
Mailing Address - Phone:315-777-3616
Mailing Address - Fax:
Practice Address - Street 1:422 COLLEGE HTS APT 2
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1846
Practice Address - Country:US
Practice Address - Phone:315-777-3616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269959-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse