Individual
LORA LUMUBOS MAMUYAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
18 1ST AVE, HOLTSVILLE, NY 11742-4208
(631) 902-8439
Mailing address
18 1ST AVE, HOLTSVILLE, NY 11742-4208
(631) 902-8439
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F307956-1
NY
Other
Enumeration date
06/22/2017
Last updated
06/22/2017
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