Provider Demographics
NPI:1831491539
Name:GRAINER-CEDERQUIST, LAURIE ANN (RN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:GRAINER-CEDERQUIST
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 1:8804 CAZENOVIA RD
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-9524
Mailing Address - Country:US
Mailing Address - Phone:315-682-5331
Mailing Address - Fax:
Practice Address - Street 1:375 W ONONDAGA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1888
Practice Address - Country:US
Practice Address - Phone:315-478-0610
Practice Address - Fax:315-478-2510
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242411163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator