Provider Demographics
NPI:1548537897
Name:HEDBERG, LAURA J (RN)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:J
Last Name:HEDBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:OTISVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10963-0071
Mailing Address - Country:US
Mailing Address - Phone:845-412-5245
Mailing Address - Fax:
Practice Address - Street 1:2320 ROUTE 6
Practice Address - Street 2:
Practice Address - City:SLATE HILL
Practice Address - State:NY
Practice Address - Zip Code:10973-3628
Practice Address - Country:US
Practice Address - Phone:845-355-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY509532163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool