Provider Demographics
NPI:1629122429
Name:MCDERMOTT, LAURA LOUISE (FNP, MS,RN)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LOUISE
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:FNP, MS,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1521
Mailing Address - Country:US
Mailing Address - Phone:607-336-2400
Mailing Address - Fax:607-334-5618
Practice Address - Street 1:157 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1521
Practice Address - Country:US
Practice Address - Phone:607-336-2400
Practice Address - Fax:607-334-5618
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY552842-1163W00000X
ARR76651163W00000X
NYF320066-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse