Provider Demographics
NPI:1386011302
Name:ANDERSON, DEIRDRE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:MARIE
Last Name:ANDERSON
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 1:73 MULBERRY CMNS
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2657
Mailing Address - Country:US
Mailing Address - Phone:631-591-0332
Mailing Address - Fax:
Practice Address - Street 1:73 MULBERRY CMNS
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2657
Practice Address - Country:US
Practice Address - Phone:631-591-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256020-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse