Provider Demographics
NPI:1518392265
Name:LAURICELLA, MARY E (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:LAURICELLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 AUTUMN CHAPEL WAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-5303
Mailing Address - Country:US
Mailing Address - Phone:585-719-5000
Mailing Address - Fax:
Practice Address - Street 1:155 AUTUMN CHAPEL WAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5303
Practice Address - Country:US
Practice Address - Phone:585-719-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY672187-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse