Provider Demographics
NPI:1568706265
Name:LAURORE, MYRLENE (RN)
Entity Type:Individual
Prefix:
First Name:MYRLENE
Middle Name:
Last Name:LAURORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:MYRLENE
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3509 JOHN PAUL JONES LN
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-4942
Mailing Address - Country:US
Mailing Address - Phone:845-290-7807
Mailing Address - Fax:
Practice Address - Street 1:3509 JOHN PAUL JONES LN
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-4942
Practice Address - Country:US
Practice Address - Phone:845-290-7807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY607895-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1969Medicaid
NY1969Medicaid