Provider Demographics
NPI:1609163070
Name:PEMBERTON, LAURA H (RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:H
Last Name:PEMBERTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 SO 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4407
Mailing Address - Country:US
Mailing Address - Phone:914-755-7040
Mailing Address - Fax:
Practice Address - Street 1:800 BAYCHESTER AVE.
Practice Address - Street 2:PABLO CASALS MS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10475-1702
Practice Address - Country:US
Practice Address - Phone:718-904-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289052163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse