Healthcare Provider Details

I. General information

NPI: 1518120914
Provider Name (Legal Business Name): LAUREN MARIE BRUST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1074 OLD COUNTRY RD
PLAINVIEW NY
11803-4918
US

IV. Provider business mailing address

2389 WILLOUGHBY AVE
SEAFORD NY
11783-2927
US

V. Phone/Fax

Practice location:
  • Phone: 516-939-2229
  • Fax: 516-939-2252
Mailing address:
  • Phone: 516-939-2229
  • Fax: 516-939-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number473497
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: