Healthcare Provider Details

I. General information

NPI: 1588579122
Provider Name (Legal Business Name): LAUREL MARGARET CONNEELY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CHARLES ST
PAINTED POST NY
14870-1100
US

IV. Provider business mailing address

13 CRESTWOOD RD
CORNING NY
14830-3330
US

V. Phone/Fax

Practice location:
  • Phone: 607-936-3704
  • Fax:
Mailing address:
  • Phone: 434-987-2452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number683569
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: