=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013491695
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN MICHELLE DURANTE NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2018
-----------------------------------------------------
Last Update Date | 09/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 143 FROEHLICH FARM BLVD
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11797-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-496-7757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3779 CHARLES CT
-----------------------------------------------------
City | SEAFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11783-2155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-551-5187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 308854
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------