Provider Demographics
NPI:1548021892
Name:ACHALAL, LAURA DIANE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:DIANE
Last Name:ACHALAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:DIANE
Other - Last Name:SELTZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 HANSEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3136
Mailing Address - Country:US
Mailing Address - Phone:516-301-7077
Mailing Address - Fax:
Practice Address - Street 1:131 N MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1911
Practice Address - Country:US
Practice Address - Phone:845-348-3518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY705556163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool