MEDICARE: LAURA FLORMAN PMHNP, 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN2272332	MA

General Provider Information

NPI Number	:	1326462698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA FLORMAN PMHNP, RN

Provider Business Mailing Address
First Line	:	19 TACOMA ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01605-3516
Country	:	US
Telephone Number	:	508-852-1805
Fax Number	:	508-853-8593

Provider Business Practice Location Address
First Line	:	2000 CENTURY DR
Second Line	:	CREDENTIALING-ADMINITRATION
City	:	WORCESTER
State	:	MA
Zip	:	01606-1256
Country	:	US
Telephone Number	:	508-854-2122
Fax Number	:	508-853-8593

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

Provider Enumeration Date	:	02/07/2014
Last Update Date	:	09/03/2020

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