Provider Demographics
NPI:1396361911
Name:SICKE, LAURA NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:NICOLE
Last Name:SICKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:
Practice Address - Street 1:1182 TROY SCHENECTADY ROAD SUITE 100
Practice Address - Street 2:ST. PETER'S SPINE AND NEUROSURGERY
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1000
Practice Address - Country:US
Practice Address - Phone:518-713-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346057363LF0000X
NY695600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse