Provider Demographics
NPI:1154622280
Name:LOPER PINCUS, DONNA LYNN (LPN)
Entity type:Individual
Prefix:MISS
First Name:DONNA
Middle Name:LYNN
Last Name:LOPER PINCUS
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 1:107 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-5316
Mailing Address - Country:US
Mailing Address - Phone:631-626-6721
Mailing Address - Fax:
Practice Address - Street 1:107 BAY AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-5316
Practice Address - Country:US
Practice Address - Phone:631-626-6721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK293700164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse