Provider Demographics
NPI:1275684144
Name:LAINE, ROSAIRE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ROSAIRE
Middle Name:
Last Name:LAINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ROSAIRE
Other - Middle Name:
Other - Last Name:LAINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:10452 NW 48TH MNR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1730
Mailing Address - Country:US
Mailing Address - Phone:516-273-0163
Mailing Address - Fax:866-697-4617
Practice Address - Street 1:2376 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2030
Practice Address - Country:US
Practice Address - Phone:516-273-0163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304165363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03641756Medicaid
NJ0362301Medicaid