Provider Demographics
NPI:1184003816
Name:KRISTOFERSON, LAURANNE
Entity type:Individual
Prefix:
First Name:LAURANNE
Middle Name:
Last Name:KRISTOFERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:KRISTOFERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:16 BIRD LN
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524-3736
Mailing Address - Country:US
Mailing Address - Phone:845-737-3739
Mailing Address - Fax:
Practice Address - Street 1:16 BIRD LN
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524-3736
Practice Address - Country:US
Practice Address - Phone:845-737-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194460164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse