Provider Demographics
NPI:1851905186
Name:GLEASON, LAURA MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:GLEASON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:GODIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:360 US HIGHWAY 1 BYP UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:603-410-6700
Mailing Address - Fax:603-319-8308
Practice Address - Street 1:20 COMMERCIAL RD STE 2
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3339
Practice Address - Country:US
Practice Address - Phone:978-798-6896
Practice Address - Fax:978-798-6897
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2274347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily