MEDICARE: LAURA FENTON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WI0500X	Infusion Therapy Registered Nurse	9340289	FL
2	163WI0500X	Infusion Therapy Registered Nurse	753676	NY

General Provider Information

NPI Number	:	1154152619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA FENTON RN

Provider Business Mailing Address
First Line	:	31023 COUNTY ROAD 435
Second Line	:
City	:	SORRENTO
State	:	FL
Zip	:	32776-7521
Country	:	US
Telephone Number	:	817-791-7131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1708 PARKVIEW AVE APT 1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-5014
Country	:	US
Telephone Number	:	817-791-7131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/08/2024

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