Provider Demographics
NPI:1952735847
Name:MACCONE, LAURA B (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:B
Last Name:MACCONE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PROSPECT AVE STE 602
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1962
Mailing Address - Country:US
Mailing Address - Phone:551-206-1338
Mailing Address - Fax:
Practice Address - Street 1:20 PROSPECT AVE STE 602
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1962
Practice Address - Country:US
Practice Address - Phone:551-996-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00457400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily