Provider Demographics
NPI:1114049970
Name:PARRA, LAURA ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:PARRA
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 1:4 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-1006
Mailing Address - Country:US
Mailing Address - Phone:631-224-8976
Mailing Address - Fax:631-277-0851
Practice Address - Street 1:81 GRANDVIEW ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3536
Practice Address - Country:US
Practice Address - Phone:631-424-5759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY469792163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01560874Medicaid