Provider Demographics
NPI:1730299850
Name:KUECK, LORRAINE (LPN)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:
Last Name:KUECK
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 1:115 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-5403
Mailing Address - Country:US
Mailing Address - Phone:631-855-2077
Mailing Address - Fax:631-851-3858
Practice Address - Street 1:120 PLANT AVE
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3805
Practice Address - Country:US
Practice Address - Phone:631-851-3810
Practice Address - Fax:631-851-3858
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155820-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse