MEDICARE: MS. LAURIE ANNE MICHAELS 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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	500314	NY

General Provider Information

NPI Number	:	1417170747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE ANNE MICHAELS RN

Provider Business Mailing Address
First Line	:	4 GRENDON LANE
Second Line	:
City	:	FARMINGVILLE
State	:	NY
Zip	:	11738-1015
Country	:	US
Telephone Number	:	631-580-0597
Fax Number	:

Provider Business Practice Location Address
First Line	:	EAST END CLINIC
Second Line	:	300 CENTER DRIVE
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-0000
Country	:	US
Telephone Number	:	631-852-2680
Fax Number	:	631-852-2674

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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