Provider Demographics
NPI:1982900916
Name:NORMAN, KEVIN N (LPN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:N
Last Name:NORMAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4033
Mailing Address - Country:US
Mailing Address - Phone:631-654-8534
Mailing Address - Fax:631-654-8534
Practice Address - Street 1:137 OAK ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-4033
Practice Address - Country:US
Practice Address - Phone:631-654-8534
Practice Address - Fax:631-654-8534
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298278164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse