Provider Demographics
NPI:1114566007
Name:AVERY, LAURA KATHRYN (FNP-C)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:KATHRYN
Last Name:AVERY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 POLIFLY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1749
Mailing Address - Country:US
Mailing Address - Phone:551-996-8697
Mailing Address - Fax:201-441-9963
Practice Address - Street 1:155 POLIFLY RD
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1758
Practice Address - Country:US
Practice Address - Phone:551-996-8697
Practice Address - Fax:201-441-9963
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00948000363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner