Healthcare Provider Details

I. General information

NPI: 1326412255
Provider Name (Legal Business Name): LORRAINE RODRIGUEZ MSN,FNP,BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SEMINARY HILL RD
CARMEL NY
10512-1921
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 845-225-3400
  • Fax:
Mailing address:
  • Phone: 212-241-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number609662-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340028-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: