Provider Demographics
NPI:1154521581
Name:REUTZEL, LAURA MARIE (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:REUTZEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:HALPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:
Practice Address - Street 1:713 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 215
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2490
Practice Address - Country:US
Practice Address - Phone:518-713-5347
Practice Address - Fax:518-713-5359
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335240363LF0000X
NVF335240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily