Provider Demographics
NPI:1902171887
Name:TIMBERLAKE, LURADINE (RN)
Entity type:Individual
Prefix:MS
First Name:LURADINE
Middle Name:
Last Name:TIMBERLAKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 GRAND AVE RM 231
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1533
Mailing Address - Country:US
Mailing Address - Phone:718-533-6567
Mailing Address - Fax:718-478-7538
Practice Address - Street 1:7250 GRAND AVE RM 231
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1533
Practice Address - Country:US
Practice Address - Phone:718-533-6567
Practice Address - Fax:718-478-7538
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242553-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool