Provider Demographics
NPI:1831462878
Name:BRUSH, LAWRENCE ANDREW (LPN)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ANDREW
Last Name:BRUSH
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 BOYLE RD
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-1948
Mailing Address - Country:US
Mailing Address - Phone:646-479-1786
Mailing Address - Fax:
Practice Address - Street 1:166 BOYLE RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-1948
Practice Address - Country:US
Practice Address - Phone:646-479-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307565-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse