Provider Demographics
NPI:1134716772
Name:VERNACCHIO, SUGEIRY LOURDES (LPN)
Entity type:Individual
Prefix:
First Name:SUGEIRY
Middle Name:LOURDES
Last Name:VERNACCHIO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SUGEIRY
Other - Middle Name:LOURDES
Other - Last Name:VERNACCHIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:8 BANTA PL
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1104
Mailing Address - Country:US
Mailing Address - Phone:201-665-7532
Mailing Address - Fax:
Practice Address - Street 1:8 BANTA PL
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1104
Practice Address - Country:US
Practice Address - Phone:201-665-7532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP07721300164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty