Provider Demographics
NPI:1609168400
Name:LASKI, MICHELLE (APN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:LASKI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-3409
Mailing Address - Country:US
Mailing Address - Phone:201-727-9330
Mailing Address - Fax:201-425-4527
Practice Address - Street 1:103 18TH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-3409
Practice Address - Country:US
Practice Address - Phone:201-727-9330
Practice Address - Fax:201-425-4527
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N011515900163WR0006X
NJ26NJ00708100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant