Provider Demographics
NPI:1578901906
Name:CASERTA, LAURA ANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:CASERTA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 EAST STATE STREET
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-0000
Mailing Address - Country:US
Mailing Address - Phone:518-752-5275
Mailing Address - Fax:518-752-5277
Practice Address - Street 1:434 SOUTH KINGSBORO AVENUE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-0010
Practice Address - Country:US
Practice Address - Phone:518-752-5275
Practice Address - Fax:518-752-5277
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYOTH000Medicare UPIN