Provider Demographics
NPI:1205293339
Name:EICHLER, LAURA ANN
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:EICHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:10244 ST RT 28
Mailing Address - City:MERIDALE
Mailing Address - State:NY
Mailing Address - Zip Code:13806
Mailing Address - Country:US
Mailing Address - Phone:607-267-7686
Mailing Address - Fax:
Practice Address - Street 1:10244 STATE RT 28
Practice Address - Street 2:
Practice Address - City:MERIDALE
Practice Address - State:NY
Practice Address - Zip Code:13806
Practice Address - Country:US
Practice Address - Phone:607-267-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302691164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse