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General NPI Number Information
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NPI Number | 1114447166
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Entity Type | Individual
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Provider Name | LAURIE B TEAL PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 725 JUNIPER SWAMP RD
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City | SHUSHAN
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State | NY
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Zip | 12873-2910
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Country | US
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Telephone | 518-812-6842
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Fax | 518-338-0174
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Provider Business Mailing Address
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Address Line | 725 JUNIPER SWAMP RD
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City | SHUSHAN
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State | NY
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Zip | 12873-2910
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Country | US
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Telephone | 518-812-6842
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Fax | 518-338-0174
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 101-0131597
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License Number State | VT
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