Provider Demographics
NPI:1740739754
Name:MALDONADO, LORA VICTORIA (LPN)
Entity Type:Individual
Prefix:MS
First Name:LORA
Middle Name:VICTORIA
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:LORA
Other - Middle Name:VICTORIA
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:113 BEACH 56TH PL APT 302
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1936
Mailing Address - Country:US
Mailing Address - Phone:718-524-3206
Mailing Address - Fax:
Practice Address - Street 1:113 BEACH 56TH PL APT 302
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1936
Practice Address - Country:US
Practice Address - Phone:718-524-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316269164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY316269OtherLICENSE NUMBER