Provider Demographics
NPI:1619156791
Name:DOUGLAS, LENA MAY (LPN)
Entity Type:Individual
Prefix:MISS
First Name:LENA
Middle Name:MAY
Last Name:DOUGLAS
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 1:624 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1317
Mailing Address - Country:US
Mailing Address - Phone:516-333-1992
Mailing Address - Fax:
Practice Address - Street 1:624 DUKE ST
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1317
Practice Address - Country:US
Practice Address - Phone:516-333-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5161762164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse