Provider Demographics
NPI:1780667998
Name:CONNORS, LAURIE MARIE (DNP, FNP, AGN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:MARIE
Last Name:CONNORS
Suffix:
Gender:F
Credentials:DNP, FNP, AGN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 21ST AVE S OFC 603B
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37240-1119
Mailing Address - Country:US
Mailing Address - Phone:716-592-4985
Mailing Address - Fax:
Practice Address - Street 1:461 21ST AVE S OFC 603B
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37240-0001
Practice Address - Country:US
Practice Address - Phone:716-592-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB2783Medicare ID - Type Unspecified
NY01972870Medicaid