Provider Demographics
NPI:1528313319
Name:VANDEWERKER, LORETTA LYNN (LPN)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:LYNN
Last Name:VANDEWERKER
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 1:5447 US HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:EAST SPRINGFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13333-1003
Mailing Address - Country:US
Mailing Address - Phone:607-437-2244
Mailing Address - Fax:
Practice Address - Street 1:5447 US HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:EAST SPRINGFIELD
Practice Address - State:NY
Practice Address - Zip Code:13333
Practice Address - Country:US
Practice Address - Phone:607-437-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297771164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse