Provider Demographics
NPI:1528014784
Name:THAYER, LAURA M (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:THAYER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 COUNTY HIGHWAY 26
Mailing Address - Street 2:
Mailing Address - City:FLY CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:13337-2703
Mailing Address - Country:US
Mailing Address - Phone:607-547-7880
Mailing Address - Fax:607-547-3917
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1301
Practice Address - Country:US
Practice Address - Phone:607-547-7880
Practice Address - Fax:607-547-7880
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02702876Medicaid
NY02702876Medicaid
NYQ57596Medicare UPIN