MEDICARE: MS. ALLYSON LORRAINE RODRIGUEZ LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	10313349	NY

General Provider Information

NPI Number	:	1205175833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALLYSON LORRAINE RODRIGUEZ LPN

Provider Business Mailing Address
First Line	:	414 ANN STREET
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702
Country	:	US
Telephone Number	:	631-639-6934
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 ANN ST
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-1104
Country	:	US
Telephone Number	:	631-639-6934
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2013
Last Update Date	:	02/01/2013

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