Provider Demographics
NPI:1063183036
Name:FORMANES, LORRAINE RAAGAS (DNP, APN, CPNP)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:RAAGAS
Last Name:FORMANES
Suffix:
Gender:F
Credentials:DNP, APN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1563
Mailing Address - Country:US
Mailing Address - Phone:908-508-0400
Mailing Address - Fax:
Practice Address - Street 1:556 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1563
Practice Address - Country:US
Practice Address - Phone:908-508-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01199100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty