Provider Demographics
NPI:1790013571
Name:DELA CRUZ, EVELYN MOCOY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:MOCOY
Last Name:DELA CRUZ
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 1:18 ROCCO DR
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4003
Mailing Address - Country:US
Mailing Address - Phone:845-321-6180
Mailing Address - Fax:
Practice Address - Street 1:18 ROCCO DR
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4003
Practice Address - Country:US
Practice Address - Phone:845-321-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289145-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse