Provider Demographics
NPI:1336461052
Name:ROC, LUMNA (LPN)
Entity Type:Individual
Prefix:
First Name:LUMNA
Middle Name:
Last Name:ROC
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 1:24934 147TH RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2430
Mailing Address - Country:US
Mailing Address - Phone:718-525-8033
Mailing Address - Fax:
Practice Address - Street 1:24934 147TH RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2430
Practice Address - Country:US
Practice Address - Phone:718-525-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285728164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY285728OtherNYS NURSING LICENSE LPN