Provider Demographics
NPI:1215238712
Name:JOSEPH, LAURETTA MAXINE (NP)
Entity type:Individual
Prefix:MS
First Name:LAURETTA
Middle Name:MAXINE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:440 LENOX RD
Mailing Address - Street 2:APT.,5S
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2023
Mailing Address - Country:US
Mailing Address - Phone:718-484-0716
Mailing Address - Fax:718-484-0716
Practice Address - Street 1:450 CLARKSON AVE # 33
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-270-4456
Practice Address - Fax:718-270-2477
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF303436363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health