Provider Demographics
NPI:1881847622
Name:ROSEN, LAURA MAI (RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MAI
Last Name:ROSEN
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:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:GLENFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12433-0344
Mailing Address - Country:US
Mailing Address - Phone:845-657-7776
Mailing Address - Fax:
Practice Address - Street 1:345 GLENFORD WITTENBERG ROAD
Practice Address - Street 2:
Practice Address - City:GLENFORD
Practice Address - State:NY
Practice Address - Zip Code:12433-0344
Practice Address - Country:US
Practice Address - Phone:845-657-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY356173-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse