Provider Demographics
NPI:1780138925
Name:LAUB, CAROLINE KANE (NP)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:KANE
Last Name:LAUB
Suffix:
Gender:
Credentials:NP
Other - Prefix:MISS
Other - First Name:CAROLINE
Other - Middle Name:CARNEY
Other - Last Name:KANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:43 LEWIS BAY RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5235
Mailing Address - Country:US
Mailing Address - Phone:774-552-6050
Mailing Address - Fax:
Practice Address - Street 1:43 LEWIS BAY RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5235
Practice Address - Country:US
Practice Address - Phone:774-552-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016581363LF0000X
MARN2296514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110119828AMedicaid