Provider Demographics
NPI:1841713500
Name:CHIARELLO, LAURETTA ANN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:LAURETTA
Middle Name:ANN
Last Name:CHIARELLO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TOWNLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5635
Mailing Address - Country:US
Mailing Address - Phone:917-270-5790
Mailing Address - Fax:
Practice Address - Street 1:229 MAYBERRY PROMENADE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6414
Practice Address - Country:US
Practice Address - Phone:718-317-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334906-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse