Provider Demographics
NPI:1427388123
Name:OLIN, LAURA LEE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:OLIN
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 1:3991 MILL RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13072-3121
Mailing Address - Country:US
Mailing Address - Phone:315-837-4385
Mailing Address - Fax:
Practice Address - Street 1:3991 MILL RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:NY
Practice Address - Zip Code:13072-3121
Practice Address - Country:US
Practice Address - Phone:315-837-4385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224956-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse