Provider Demographics
NPI:1447867478
Name:BERKELEY, LAURA LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LYNN
Last Name:BERKELEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX147 54 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HARPURSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13787
Mailing Address - Country:US
Mailing Address - Phone:607-693-8119
Mailing Address - Fax:607-693-8007
Practice Address - Street 1:54 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARPURSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13787-1903
Practice Address - Country:US
Practice Address - Phone:607-693-8119
Practice Address - Fax:607-693-8007
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY679151163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool