Healthcare Provider Details

I. General information

NPI: 1497059174
Provider Name (Legal Business Name): ROBERTA LEMAIRE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 ARGYLE DR
SMITH POINT NY
11967-4202
US

IV. Provider business mailing address

42 ARGYLE DR
SMITH POINT NY
11967-4202
US

V. Phone/Fax

Practice location:
  • Phone: 631-578-6871
  • Fax: 631-772-1661
Mailing address:
  • Phone: 631-578-6871
  • Fax: 631-772-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number355680-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: