Provider Demographics
NPI:1750630034
Name:HENNIGER, LAURA ANNE (RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:HENNIGER
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 1:25 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-6145
Mailing Address - Country:US
Mailing Address - Phone:518-344-2910
Mailing Address - Fax:
Practice Address - Street 1:897 BIRCHWOOD LN
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-3111
Practice Address - Country:US
Practice Address - Phone:518-344-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY499073163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool