Provider Demographics
NPI:1952620262
Name:YACINO, LAURA MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARIE
Last Name:YACINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:NARROWSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12764-6200
Mailing Address - Country:US
Mailing Address - Phone:718-441-2835
Mailing Address - Fax:718-805-6041
Practice Address - Street 1:13020 89TH RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-3301
Practice Address - Country:US
Practice Address - Phone:718-441-2835
Practice Address - Fax:718-805-6041
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY469812-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY469812-1OtherNYS REGISTERED PROFESSIONAL NURSE LICENSE #