Healthcare Provider Details

I. General information

NPI: 1417314600
Provider Name (Legal Business Name): LONNA ELLEN VROOMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N HERMAN AVE
AUBURN NY
13021-2945
US

IV. Provider business mailing address

3623 SWARTOUT RD
AUBURN NY
13021-9646
US

V. Phone/Fax

Practice location:
  • Phone: 315-255-8686
  • Fax: 315-255-8693
Mailing address:
  • Phone: 315-255-8686
  • Fax: 315-255-8693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number450209
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: