Provider Demographics
NPI:1942363478
Name:GIMBY, LAURA BURT (APRNBC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:BURT
Last Name:GIMBY
Suffix:
Gender:F
Credentials:APRNBC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:BURT
Other - Last Name:FRANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 CHANDLER STREET
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472
Mailing Address - Country:US
Mailing Address - Phone:617-312-2792
Mailing Address - Fax:
Practice Address - Street 1:24 CHANDLER STREET
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472
Practice Address - Country:US
Practice Address - Phone:617-312-2792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200297RNPC163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PN0855OtherBCBS
GINS0770Medicare ID - Type Unspecified