Provider Demographics
NPI:1013424449
Name:SEXTON, LAURA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:SEXTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1219
Mailing Address - Country:US
Mailing Address - Phone:607-382-9963
Mailing Address - Fax:
Practice Address - Street 1:134 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1219
Practice Address - Country:US
Practice Address - Phone:607-382-9963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328437-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYGB22940MMedicaid