Provider Demographics
NPI:1497114854
Name:FOWLKES-LORMINIER, DEANNA MARIE (NURSE)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:FOWLKES-LORMINIER
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7103
Mailing Address - Country:US
Mailing Address - Phone:516-402-1426
Mailing Address - Fax:
Practice Address - Street 1:187 PERRY ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-5221
Practice Address - Country:US
Practice Address - Phone:516-402-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-14
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279889-01251J00000X
NY279889-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No251J00000XAgenciesNursing Care