Provider Demographics
NPI:1649075722
Name:LAU, ISABELLA ROSE (RN)
Entity type:Individual
Prefix:MRS
First Name:ISABELLA
Middle Name:ROSE
Last Name:LAU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ISABELLA
Other - Middle Name:ROSE
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:20907 56TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:72 GUY LOMBARDO AVE STE 2
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3742
Practice Address - Country:US
Practice Address - Phone:516-226-3615
Practice Address - Fax:516-223-5000
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY948698163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool