Provider Demographics
NPI:1548652985
Name:LAURELLI, LAUREN (APRN, RNFA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LAURELLI
Suffix:
Gender:F
Credentials:APRN, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 STONELEIGH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3940
Mailing Address - Country:US
Mailing Address - Phone:845-278-8400
Mailing Address - Fax:845-278-4323
Practice Address - Street 1:664 STONELEIGH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3940
Practice Address - Country:US
Practice Address - Phone:845-278-8400
Practice Address - Fax:845-278-4323
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7613363LF0000X
NY339380363LF0000X
NY613197163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04155560Medicaid