Healthcare Provider Details

I. General information

NPI: 1134993678
Provider Name (Legal Business Name): LAURANE YEARWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 DUMONT AVE
STATEN ISLAND NY
10305-1450
US

IV. Provider business mailing address

126 GRANDVIEW AVENUE APT 6
STATEN ISLAND NY
10303
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-8510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number348893
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: