Provider Demographics
NPI:1245019850
Name:PAUL, LOURDES MARJORIE (LPN)
Entity type:Individual
Prefix:MISS
First Name:LOURDES
Middle Name:MARJORIE
Last Name:PAUL
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 1:1919 CHESTNUT ST APT 2123
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3438
Mailing Address - Country:US
Mailing Address - Phone:516-491-0795
Mailing Address - Fax:
Practice Address - Street 1:1919 CHESTNUT ST APT 2123
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3438
Practice Address - Country:US
Practice Address - Phone:518-491-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN270127164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse