Provider Demographics
NPI:1689987356
Name:SUTHERLAND, LILLIAN VERDA (RN)
Entity Type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:VERDA
Last Name:SUTHERLAND
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 1:1256 E 103RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4502
Mailing Address - Country:US
Mailing Address - Phone:718-251-7791
Mailing Address - Fax:
Practice Address - Street 1:1256 E 103RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4502
Practice Address - Country:US
Practice Address - Phone:718-251-7791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3725301163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse