Provider Demographics
NPI:1124276779
Name:TOOHEY, LAURI ANN (ANP)
Entity type:Individual
Prefix:
First Name:LAURI
Middle Name:ANN
Last Name:TOOHEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:LAURI
Other - Middle Name:ANN
Other - Last Name:NEWBOULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-595-2000
Mailing Address - Fax:508-853-7149
Practice Address - Street 1:630 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2038
Practice Address - Country:US
Practice Address - Phone:508-595-2000
Practice Address - Fax:508-853-7149
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211175363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0719633Medicare PIN