Provider Demographics
NPI:1023376985
Name:LOPPE-GREGOIRE, MIRLANDE (LPN)
Entity type:Individual
Prefix:MISS
First Name:MIRLANDE
Middle Name:
Last Name:LOPPE-GREGOIRE
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 1:460 E 19TH ST
Mailing Address - Street 2:PH
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6706
Mailing Address - Country:US
Mailing Address - Phone:646-234-7664
Mailing Address - Fax:
Practice Address - Street 1:460 E 19TH ST
Practice Address - Street 2:PH
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6706
Practice Address - Country:US
Practice Address - Phone:646-234-7664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308842-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse