=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588617047
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURIE JO PRACHER F.N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 02/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 LEGION DR
-----------------------------------------------------
City | COBLESKILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12043-5111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-234-2555
-----------------------------------------------------
Fax | 518-234-3415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 725
-----------------------------------------------------
City | COOPERSTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13326-0725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-234-2555
-----------------------------------------------------
Fax | 518-234-3415
-----------------------------------------------------
=====================================================
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 | F330668
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------