Provider Demographics
NPI:1821195900
Name:PAOLETTI, LAURA J (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:PAOLETTI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:KILBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:140 W 6TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2525
Mailing Address - Country:US
Mailing Address - Phone:315-342-6215
Mailing Address - Fax:315-342-6219
Practice Address - Street 1:140 W 6TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2525
Practice Address - Country:US
Practice Address - Phone:315-342-6215
Practice Address - Fax:315-342-6219
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300684363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03046944Medicaid
NY03046944Medicaid