Provider Demographics
NPI:1942653852
Name:DENNISON, LAURIE ANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:DENNISON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PINE ST
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12832-1111
Mailing Address - Country:US
Mailing Address - Phone:518-955-8576
Mailing Address - Fax:
Practice Address - Street 1:15 PINE ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-1111
Practice Address - Country:US
Practice Address - Phone:518-955-8576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340660-1363LF0000X
NY403123-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse