Provider Demographics
NPI:1366823825
Name:FREIRE, LAURA C (APN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:FREIRE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:C
Other - Last Name:PARICIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:468 PARISH DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4671
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:468 PARISH DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4671
Practice Address - Country:US
Practice Address - Phone:973-686-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00571300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily