Provider Demographics
NPI:1750557369
Name:LAWLER-PUORRO, ELLEN (LPN)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:LAWLER-PUORRO
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 1:17 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4019
Mailing Address - Country:US
Mailing Address - Phone:631-543-4394
Mailing Address - Fax:
Practice Address - Street 1:17 LEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4019
Practice Address - Country:US
Practice Address - Phone:631-543-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-03
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182663-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse