Provider Demographics
NPI:1538458203
Name:SODERLUND, LUCILLE ANNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:ANNE
Last Name:SODERLUND
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 1:8 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11951-3603
Mailing Address - Country:US
Mailing Address - Phone:717-490-0714
Mailing Address - Fax:
Practice Address - Street 1:8 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11951-3603
Practice Address - Country:US
Practice Address - Phone:717-490-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301371-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse