Provider Demographics
NPI:1326315169
Name:JABLONSKI, LAURA ANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANNE
Last Name:JABLONSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:ANNE
Other - Last Name:NIZIURSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3631 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1733
Mailing Address - Country:US
Mailing Address - Phone:716-662-7455
Mailing Address - Fax:
Practice Address - Street 1:3631 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1733
Practice Address - Country:US
Practice Address - Phone:716-662-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY365658163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse