Provider Demographics
NPI:1033294301
Name:OLIVERO-BRODEUR, LORRAINE (DNP)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:OLIVERO-BRODEUR
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1965
Mailing Address - Country:US
Mailing Address - Phone:845-727-7733
Mailing Address - Fax:845-727-7743
Practice Address - Street 1:2 MEDICAL PARK DR
Practice Address - Street 2:SUITE 3
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1965
Practice Address - Country:US
Practice Address - Phone:845-727-7733
Practice Address - Fax:845-727-7743
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS52130Medicare UPIN