Provider Demographics
NPI:1538411749
Name:LAISE, DANA MARIE (CNM)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:MARIE
Last Name:LAISE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2650
Mailing Address - Country:US
Mailing Address - Phone:845-333-7575
Mailing Address - Fax:845-333-4663
Practice Address - Street 1:258 HIGH AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2407
Practice Address - Country:US
Practice Address - Phone:845-348-2550
Practice Address - Fax:845-348-9821
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY709342-1163W00000X
PAMW010286367A00000X
NYF001647-1176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife