Provider Demographics
NPI:1356584916
Name:MULCAHY, LAURA J (FNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:J
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 BRONXVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-1102
Mailing Address - Country:US
Mailing Address - Phone:718-882-5482
Mailing Address - Fax:718-882-5725
Practice Address - Street 1:3230 BAINBRIDGE AVE
Practice Address - Street 2:STD CENTER SUITE D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-3963
Practice Address - Country:US
Practice Address - Phone:718-882-5482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily