Provider Demographics
NPI:1578691507
Name:ERNEST, LAURIE W (MS, RNC, CNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:W
Last Name:ERNEST
Suffix:
Gender:F
Credentials:MS, RNC, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CHATWORTH CIR S
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8742
Mailing Address - Country:US
Mailing Address - Phone:585-377-0596
Mailing Address - Fax:
Practice Address - Street 1:1000 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2733
Practice Address - Country:US
Practice Address - Phone:585-341-8057
Practice Address - Fax:585-341-8205
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277696-1163W00000X
NYF420203-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYME0061135OtherDEA