=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487333647
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A REGISTERED PROFESSIONAL NURSE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2023
-----------------------------------------------------
Last Update Date | 07/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 PIERMONT AVE
-----------------------------------------------------
City | NYACK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-745-5157
-----------------------------------------------------
Fax | 845-684-0794
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 48 S BROADWAY UNIT 622
-----------------------------------------------------
City | NYACK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10960-7555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-745-5157
-----------------------------------------------------
Fax | 845-684-0794
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC NURSE PRACTITIONER
-----------------------------------------------------
Name | LAURA COLEMAN
-----------------------------------------------------
Credential | PMHNP-BC, NC-BC
-----------------------------------------------------
Telephone | 917-745-5157
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------