Provider Demographics
NPI:1457683096
Name:DIAZ, LORRAINE MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:MARIE
Last Name:DIAZ
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 1:380 WASHINGTON AVENUE
Mailing Address - Street 2:UNITED CEREBRAL PALSY
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575
Mailing Address - Country:US
Mailing Address - Phone:516-378-2000
Mailing Address - Fax:516-377-2081
Practice Address - Street 1:380 WASHINGTON AVENUE
Practice Address - Street 2:UNITED CEREBRAL PALSY
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:516-378-2000
Practice Address - Fax:516-377-2081
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221389-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse