Provider Demographics
NPI:1487388153
Name:LUGO, STEPHANIE (LPN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LUGO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:LUGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:38 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4546
Mailing Address - Country:US
Mailing Address - Phone:347-200-0225
Mailing Address - Fax:
Practice Address - Street 1:143 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2005
Practice Address - Country:US
Practice Address - Phone:917-930-6082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341744164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse