Provider Demographics
NPI:1871301317
Name:DZIUBA, KAREN LYNN (LPN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:DZIUBA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 ROUTE 19A
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14735-8602
Mailing Address - Country:US
Mailing Address - Phone:585-610-3315
Mailing Address - Fax:
Practice Address - Street 1:10850 ROUTE 19A
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:NY
Practice Address - Zip Code:14735-8602
Practice Address - Country:US
Practice Address - Phone:585-610-3315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298008-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse