Provider Demographics
NPI:1922219195
Name:PADILLA, DEBRA GRACE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:GRACE
Last Name:PADILLA
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 1:355 PIN OAK LN
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1941
Mailing Address - Country:US
Mailing Address - Phone:516-414-2610
Mailing Address - Fax:
Practice Address - Street 1:355 PIN OAK LN
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1941
Practice Address - Country:US
Practice Address - Phone:516-414-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00254216164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02419616Medicaid