Provider Demographics
NPI:1164467312
Name:CHURCHILL, LAURA HUTCHINS (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:HUTCHINS
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MAIN ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1363
Mailing Address - Country:US
Mailing Address - Phone:518-719-3580
Mailing Address - Fax:518-719-3797
Practice Address - Street 1:411 MAIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1318
Practice Address - Country:US
Practice Address - Phone:518-719-3580
Practice Address - Fax:518-719-3797
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-3311951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS-854-02Medicare UPIN