Provider Demographics
NPI:1477849081
Name:MONGE, LOURDES (LPN)
Entity type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:MONGE
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 1:365 ST ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-2713
Mailing Address - Country:US
Mailing Address - Phone:845-778-3770
Mailing Address - Fax:
Practice Address - Street 1:365 ST ANDREWS RD
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-2713
Practice Address - Country:US
Practice Address - Phone:845-778-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093518164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse