Provider Demographics
NPI:1174803209
Name:DEMARIA, LAURA LYNN (APN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:DEMARIA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-771-9824
Mailing Address - Fax:
Practice Address - Street 1:180 SOUTH ST
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1991
Practice Address - Country:US
Practice Address - Phone:908-673-7505
Practice Address - Fax:908-464-4159
Is Sole Proprietor?:No
Enumeration Date:2011-08-21
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN10015900363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics