Provider Demographics
NPI:1760426548
Name:ZAKORCHEMNY, LAURA L (ARNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:ZAKORCHEMNY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112-114 SANFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-5533
Mailing Address - Country:US
Mailing Address - Phone:207-646-5211
Mailing Address - Fax:
Practice Address - Street 1:22 STRAFFORD ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-4701
Practice Address - Country:US
Practice Address - Phone:603-366-1070
Practice Address - Fax:603-366-1071
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH061631-23363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1760426548Medicaid
DE1760426548Medicaid