Provider Demographics
NPI:1487831962
Name:MISTRETTA, LORENE MARGARET (RN)
Entity Type:Individual
Prefix:MS
First Name:LORENE
Middle Name:MARGARET
Last Name:MISTRETTA
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 1:238 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3109
Mailing Address - Country:US
Mailing Address - Phone:631-235-2470
Mailing Address - Fax:
Practice Address - Street 1:238 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3109
Practice Address - Country:US
Practice Address - Phone:631-235-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-27
Last Update Date:2008-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY564009-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics