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General NPI Number Information
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NPI Number | 1033652631
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Entity Type | Individual
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Provider Name | LORRAINE IVETTE BELEVAN
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Gender | Female
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 92 DRAKEFORD AVE
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City | NORTH BABYLON
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State | NY
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Zip | 11703-2613
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Country | US
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Telephone | 631-897-9897
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Fax |
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Provider Business Mailing Address
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Address Line | 92 DRAKEFORD AVE
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City | NORTH BABYLON
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State | NY
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Zip | 11703-2613
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Country | US
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Telephone | 631-897-9897
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 30 306534
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License Number State | NY
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