Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 403689 | NY |
NPI | 1013513035 |
---|---|
Provider Name | Laura Coleman |
First Address | Nyack, NY 10960-0622 |
Second Address | New Square, NY 10977-8916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2020 |
Last Update Date | 06/10/2021 |