Provider Demographics
NPI:1154066546
Name:MIDDLETON, LAURA LEE (LPN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142-0317
Mailing Address - Country:US
Mailing Address - Phone:315-341-4509
Mailing Address - Fax:
Practice Address - Street 1:3811 US ROUTE 11
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:NY
Practice Address - Zip Code:13142-2125
Practice Address - Country:US
Practice Address - Phone:315-314-4509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-01
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332872164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty