Provider Demographics
NPI:1376943167
Name:LAIRD, PAULETTE NOELINE
Entity Type:Individual
Prefix:MISS
First Name:PAULETTE
Middle Name:NOELINE
Last Name:LAIRD
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 1:20514 LINDEN BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2934
Mailing Address - Country:US
Mailing Address - Phone:718-528-5493
Mailing Address - Fax:
Practice Address - Street 1:20514 LINDEN BLVD STE 204
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2934
Practice Address - Country:US
Practice Address - Phone:718-528-5493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203657-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse