Provider Demographics
NPI:1518551373
Name:ULRICH, LAURA ELIZABETH
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:ULRICH
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 1:39 BANK ST
Mailing Address - Street 2:
Mailing Address - City:NEWFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14867-9311
Mailing Address - Country:US
Mailing Address - Phone:607-228-0448
Mailing Address - Fax:
Practice Address - Street 1:39 BANK ST
Practice Address - Street 2:
Practice Address - City:NEWFIELD
Practice Address - State:NY
Practice Address - Zip Code:14867-9311
Practice Address - Country:US
Practice Address - Phone:607-228-0448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-302541174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN