Provider Demographics
NPI:1104053651
Name:WASHINGTON, LORRAINE MARIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:MARIE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:LORRIAINE
Other - Middle Name:MARIE
Other - Last Name:HERVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:79 FLOSS AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-1901
Mailing Address - Country:US
Mailing Address - Phone:716-464-8482
Mailing Address - Fax:
Practice Address - Street 1:79 FLOSS AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-1901
Practice Address - Country:US
Practice Address - Phone:716-464-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226818-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse