Provider Demographics
NPI:1508026667
Name:LORUSSO, LORIELLEN E (RNC, NP)
Entity Type:Individual
Prefix:
First Name:LORIELLEN
Middle Name:E
Last Name:LORUSSO
Suffix:
Gender:F
Credentials:RNC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 ROUTE 347 STE 70
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2061
Mailing Address - Country:US
Mailing Address - Phone:631-331-8777
Mailing Address - Fax:631-474-9169
Practice Address - Street 1:5225 ROUTE 347 STE 70
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2061
Practice Address - Country:US
Practice Address - Phone:631-331-8777
Practice Address - Fax:631-474-9169
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY499885363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology