Provider Demographics
NPI:1891479184
Name:DORN, LAURA (APRN- FNP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:DORN
Suffix:
Gender:F
Credentials:APRN- FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2327
Mailing Address - Country:US
Mailing Address - Phone:914-629-6773
Mailing Address - Fax:
Practice Address - Street 1:7 LOUIS AVE
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2327
Practice Address - Country:US
Practice Address - Phone:914-629-6773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF352058-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty