Provider Demographics
NPI:1568695252
Name:DIDOMENICO, ROSALIE MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:MARIE
Last Name:DIDOMENICO
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 1:63 RHAME AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1831
Mailing Address - Country:US
Mailing Address - Phone:516-284-6394
Mailing Address - Fax:
Practice Address - Street 1:63 RHAME AVE
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1831
Practice Address - Country:US
Practice Address - Phone:516-284-6394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232133164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse