Provider Demographics
NPI:1164872594
Name:LAURENT, ROSELORE
Entity Type:Individual
Prefix:
First Name:ROSELORE
Middle Name:
Last Name:LAURENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 N MAIN ST APT 9B
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3844
Mailing Address - Country:US
Mailing Address - Phone:845-826-6499
Mailing Address - Fax:
Practice Address - Street 1:160 N MAIN ST APT 9B
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3844
Practice Address - Country:US
Practice Address - Phone:845-826-6499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274091-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse