Provider Demographics
NPI:1376889840
Name:RENNIE-LUBRIN, ALICIA RENE (RN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:RENE
Last Name:RENNIE-LUBRIN
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 1:751 TROY AVE
Mailing Address - Street 2:APT. # 4L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3157
Mailing Address - Country:US
Mailing Address - Phone:718-288-9886
Mailing Address - Fax:
Practice Address - Street 1:751 TROY AVE
Practice Address - Street 2:APT. # 4L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3157
Practice Address - Country:US
Practice Address - Phone:718-288-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612636-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse