Provider Demographics
NPI:1073834115
Name:O'MEAL, LAUREN N (NPP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:N
Last Name:O'MEAL
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160K PITTSFORD VICTOR RD STE 17
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3818
Mailing Address - Country:US
Mailing Address - Phone:585-433-1336
Mailing Address - Fax:585-433-1356
Practice Address - Street 1:1160K PITTSFORD VICTOR RD STE 17
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3818
Practice Address - Country:US
Practice Address - Phone:585-433-1336
Practice Address - Fax:585-433-1356
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401275363LP0808X
NY565864163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03326294Medicaid
NYJ400042285/GRPBA0017Medicare PIN
NYJ400054311/GJ1000442Medicare PIN
NYJ400042294/GRP70008AMedicare PIN