Provider Demographics
NPI: | 1437921905 |
---|---|
Name: | LAURORE, YVESON |
Entity Type: | Individual |
Prefix: | |
First Name: | YVESON |
Middle Name: | |
Last Name: | LAURORE |
Suffix: | |
Gender: | M |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 790 BELLMORE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | NORTH BELLMORE |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11710-3727 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 516-993-1267 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 790 BELLMORE RD |
Practice Address - Street 2: | |
Practice Address - City: | NORTH BELLMORE |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11710-3727 |
Practice Address - Country: | US |
Practice Address - Phone: | 516-993-1267 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2023-10-26 |
Last Update Date: | 2023-10-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 617116-01 | 163WI0500X, 163WM0705X, 171W00000X, 163W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 163W00000X | Nursing Service Providers | Registered Nurse | ||
No | 163WI0500X | Nursing Service Providers | Registered Nurse | Infusion Therapy | Group - Multi-Specialty |
No | 163WM0705X | Nursing Service Providers | Registered Nurse | Medical-Surgical | Group - Multi-Specialty |
No | 171W00000X | Other Service Providers | Contractor |