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General NPI Number Information
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NPI Number | 1164007183
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Entity Type | Individual
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Provider Name | LAURA SHERIDAN RN-MSN
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Gender | Female
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Dates
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Enumeration Date | 03/11/2021
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 511 E COLUMBUS AVE
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City | SPRINGFIELD
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State | MA
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Zip | 01105-2506
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Country | US
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Telephone | 413-733-3488
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Fax |
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Provider Business Mailing Address
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Address Line | 511 E COLUMBUS AVE
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City | SPRINGFIELD
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State | MA
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Zip | 01105-2506
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Country | US
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Telephone |
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Fax |
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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 | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | 101042
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | RN2274789
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License Number State | MA
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