Provider Demographics
NPI:1689448946
Name:LAURISTON-JANVIER, FEDLENE (WHNP)
Entity Type:Individual
Prefix:
First Name:FEDLENE
Middle Name:
Last Name:LAURISTON-JANVIER
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 40TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2703
Mailing Address - Country:US
Mailing Address - Phone:516-967-1662
Mailing Address - Fax:
Practice Address - Street 1:180 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-2012
Practice Address - Country:US
Practice Address - Phone:631-893-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421674363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health