Provider Demographics
NPI:1427244748
Name:FLERX, LAURA (RNC, CCRN , CBC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FLERX
Suffix:
Gender:F
Credentials:RNC, CCRN , CBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1929
Mailing Address - Country:US
Mailing Address - Phone:631-331-5172
Mailing Address - Fax:
Practice Address - Street 1:23 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1929
Practice Address - Country:US
Practice Address - Phone:631-331-5172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22482463163W00000X
FLRN9228817163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0261934SMedicaid