Healthcare Provider Details

I. General information

NPI: 1588196067
Provider Name (Legal Business Name): LORRAINE K. PORCARO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E MAIN STREET DIABETES ROOM 2225E
MIDDLETOWN NY
10940
US

IV. Provider business mailing address

91 ROCK RIDGE RD
CHESTER NY
10918-2508
US

V. Phone/Fax

Practice location:
  • Phone: 845-333-2495
  • Fax:
Mailing address:
  • Phone: 914-850-3089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number456183
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: