Provider Demographics
NPI:1346733847
Name:KOTLOWSKI, LAURIE RYAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:RYAN
Last Name:KOTLOWSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:SUE
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:404 OAKDALE DR.
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2450
Mailing Address - Country:US
Mailing Address - Phone:716-828-5125
Mailing Address - Fax:
Practice Address - Street 1:404 OAKDALE DR
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2450
Practice Address - Country:US
Practice Address - Phone:716-828-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332039164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse