Provider Demographics
NPI:1104059187
Name:NAGENGAST, LAURA ANN (LPN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:NAGENGAST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 WESTBURY DR
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-1743
Mailing Address - Country:US
Mailing Address - Phone:631-849-6207
Mailing Address - Fax:
Practice Address - Street 1:7 WESTBURY DR
Practice Address - Street 2:
Practice Address - City:SOUND BEACH
Practice Address - State:NY
Practice Address - Zip Code:11789-1743
Practice Address - Country:US
Practice Address - Phone:631-849-6207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285215-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse