Provider Demographics
NPI:1487333647
Name:A REGISTERED PROFESSIONAL NURSE, PLLC
Entity type:Organization
Organization Name:A REGISTERED PROFESSIONAL NURSE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, NC-BC
Authorized Official - Phone:917-745-5157
Mailing Address - Street 1:48 S BROADWAY UNIT 622
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-7555
Mailing Address - Country:US
Mailing Address - Phone:917-745-5157
Mailing Address - Fax:845-684-0794
Practice Address - Street 1:1 PIERMONT AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960
Practice Address - Country:US
Practice Address - Phone:917-745-5157
Practice Address - Fax:845-684-0794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health