Provider Demographics
NPI:1417314600
Name:VROOMAN, LONNA ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:LONNA
Middle Name:ELLEN
Last Name:VROOMAN
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 1:3623 SWARTOUT RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-9646
Mailing Address - Country:US
Mailing Address - Phone:315-255-8686
Mailing Address - Fax:315-255-8693
Practice Address - Street 1:2 N HERMAN AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2945
Practice Address - Country:US
Practice Address - Phone:315-255-8686
Practice Address - Fax:315-255-8693
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY450209163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse