Provider Demographics
NPI:1386491769
Name:LAUREUS, VANESSA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:LAUREUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 FARRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-3059
Mailing Address - Country:US
Mailing Address - Phone:646-506-3617
Mailing Address - Fax:
Practice Address - Street 1:36 FARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-3059
Practice Address - Country:US
Practice Address - Phone:646-506-3617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347388164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse