=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548652985
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN LAURELLI APRN, RNFA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2015
-----------------------------------------------------
Last Update Date | 04/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 664 STONELEIGH AVE SUITE 300
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10512-3940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-278-8400
-----------------------------------------------------
Fax | 845-278-4323
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 664 STONELEIGH AVE SUITE 300
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10512-3940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-278-8400
-----------------------------------------------------
Fax | 845-278-4323
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 7613
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 339380
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WR0006X
-----------------------------------------------------
Taxonomy Name | Registered Nurse First Assistant
-----------------------------------------------------
License Number | 613197
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------