Provider Demographics
NPI:1649077926
Name:LAWLER -VILA, KIM M
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:M
Last Name:LAWLER -VILA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10925-0323
Mailing Address - Country:US
Mailing Address - Phone:845-500-3711
Mailing Address - Fax:
Practice Address - Street 1:15 SUFFERN PL STE A
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5566
Practice Address - Country:US
Practice Address - Phone:845-357-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY360043-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse