Provider Demographics
NPI:1174785760
Name:SUMILANG, LOURDES MOJICA (RN)
Entity type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:MOJICA
Last Name:SUMILANG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-1425
Mailing Address - Country:US
Mailing Address - Phone:201-641-5612
Mailing Address - Fax:
Practice Address - Street 1:28 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660-1425
Practice Address - Country:US
Practice Address - Phone:201-641-5612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342222163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse