Provider Demographics
NPI:1588359368
Name:PURCELL, LA TOYA M (LICENSED PRACTICAL N)
Entity type:Individual
Prefix:
First Name:LA TOYA
Middle Name:M
Last Name:PURCELL
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BETHPAGE RD
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-1415
Mailing Address - Country:US
Mailing Address - Phone:516-476-2326
Mailing Address - Fax:
Practice Address - Street 1:44 BETHPAGE RD
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-1415
Practice Address - Country:US
Practice Address - Phone:516-476-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303990164W00000X
NY303990-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse