Basic Information
| Provider Information | |||||||||
| NPI: | 1003490541 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAWLOR | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | GARAFALO | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 467 KNICKERBOCKER RD | ||||||||
| Address2: | |||||||||
| City: | SCHODACK LANDING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121569703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182250096 | ||||||||
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| Practice Location | |||||||||
| Address1: | 847 COUNTY HIGHWAY 122 | ||||||||
| Address2: | |||||||||
| City: | GLOVERSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120786413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183466121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2021 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0600X | 390637 | NY | Y | Nursing Service Providers | Registered Nurse | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 390637 | 01 | NY | NURSE LICENSE | OTHER |