Provider Demographics
NPI:1407164239
Name:QUIRINDONGO, REBECCA (LPN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:QUIRINDONGO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7 COBBLESTONE CT
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2085
Mailing Address - Country:US
Mailing Address - Phone:631-265-0563
Mailing Address - Fax:
Practice Address - Street 1:7 COBBLESTONE CT
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2085
Practice Address - Country:US
Practice Address - Phone:631-265-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228777-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse