Provider Demographics
NPI:1871967760
Name:PRIVETT, LAURA JEANNE (RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JEANNE
Last Name:PRIVETT
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 1:9 SCHOONMAKER LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1117
Mailing Address - Country:US
Mailing Address - Phone:845-591-4462
Mailing Address - Fax:
Practice Address - Street 1:118 JOSEPHS DR
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-4754
Practice Address - Country:US
Practice Address - Phone:845-591-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY684428-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health