Provider Demographics
NPI:1437608064
Name:POLLARD, LAURIE (NP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:POLLARD
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 1:36 BRITISH AMERICAN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1410
Mailing Address - Country:US
Mailing Address - Phone:518-389-6606
Mailing Address - Fax:518-389-6605
Practice Address - Street 1:36 BRITISH AMERICAN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1410
Practice Address - Country:US
Practice Address - Phone:518-389-6606
Practice Address - Fax:518-389-6605
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401906363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300338301Medicare UPIN