Provider Demographics
NPI:1932635182
Name:SUTHERLAND, LAUREN IRENE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:IRENE
Last Name:SUTHERLAND
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 1:10216 FARMERS BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-3126
Mailing Address - Country:US
Mailing Address - Phone:718-470-2563
Mailing Address - Fax:718-470-2563
Practice Address - Street 1:10216 FARMERS BLVD
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423
Practice Address - Country:US
Practice Address - Phone:718-470-2563
Practice Address - Fax:718-470-2563
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324083164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse