Provider Demographics
NPI:1992856058
Name:DIRIENZO-LAWLESS, RACHAEL (FNP-C)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:DIRIENZO-LAWLESS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4014
Mailing Address - Country:US
Mailing Address - Phone:516-747-5644
Mailing Address - Fax:516-747-2556
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4014
Practice Address - Country:US
Practice Address - Phone:516-747-5644
Practice Address - Fax:516-747-2556
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily