=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982872743
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREEN A FELLER NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2008
-----------------------------------------------------
Last Update Date | 02/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 DUNNING RD STE 1
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10940-2216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-344-4477
-----------------------------------------------------
Fax | 845-344-6072
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 158 N MAIN ST PO BOX 299
-----------------------------------------------------
City | FLORIDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10921-1133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-651-1412
-----------------------------------------------------
Fax | 845-651-1512
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | F302823
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------