Provider Demographics
NPI:1538159850
Name:VORDERBRUGGEN, JOAN (LPN)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:VORDERBRUGGEN
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 1:219 KINGSLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4358
Mailing Address - Country:US
Mailing Address - Phone:347-245-9986
Mailing Address - Fax:
Practice Address - Street 1:219 KINGSLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4367
Practice Address - Country:US
Practice Address - Phone:347-245-9986
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268644-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse