Healthcare Provider Details

I. General information

NPI: 1124784640
Provider Name (Legal Business Name): MARISA LAUREN WHITELAW CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISA LAUREN KREITMAN

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 SOUTH MANNING BLVD 3 MCAULEY
ALBANY NY
12208-1707
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 185-525-1381
  • Fax: 518-525-1717
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number948851
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number11015782
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number002319
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: