Provider Demographics
NPI:1588849293
Name:SLIZ, LAURIE GAE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:GAE
Last Name:SLIZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:LAURIE
Other - Middle Name:TROWBRIDGE
Other - Last Name:SLIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:19525 NYSR 177
Mailing Address - Street 2:
Mailing Address - City:ADAMS CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13606
Mailing Address - Country:US
Mailing Address - Phone:315-583-5594
Mailing Address - Fax:
Practice Address - Street 1:19525 NYSR 177
Practice Address - Street 2:
Practice Address - City:ADAMS CENTER
Practice Address - State:NY
Practice Address - Zip Code:13606
Practice Address - Country:US
Practice Address - Phone:315-583-5594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113669164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse