Healthcare Provider Details

I. General information

NPI: 1427020320
Provider Name (Legal Business Name): KATHLEEN LAUZON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 COUNTY ROUTE 1
FORT COVINGTON NY
12937-2805
US

IV. Provider business mailing address

526 COUNTY ROUTE 42
FORT COVINGTON NY
12937-2512
US

V. Phone/Fax

Practice location:
  • Phone: 518-358-3008
  • Fax: 518-358-9826
Mailing address:
  • Phone: 518-358-2107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF331441
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: