Provider Demographics
NPI:1679088579
Name:MENDEZ, LAURA A (LPN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:MENDEZ
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 1:278 SEMINOLE ST
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4634
Mailing Address - Country:US
Mailing Address - Phone:631-707-2404
Mailing Address - Fax:631-707-2404
Practice Address - Street 1:278 SEMINOLE ST
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4634
Practice Address - Country:US
Practice Address - Phone:631-707-2404
Practice Address - Fax:631-707-2404
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327159164W00000X
NY327159-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse