Provider Demographics
NPI:1962452722
Name:LAURICELLA, KAREN SUE (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:LAURICELLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1900 RIDGE RD
Mailing Address - Street 2:STE 130
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3332
Mailing Address - Country:US
Mailing Address - Phone:716-675-0707
Mailing Address - Fax:716-961-3706
Practice Address - Street 1:1900 RIDGE RD
Practice Address - Street 2:STE 130
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3332
Practice Address - Country:US
Practice Address - Phone:716-675-0707
Practice Address - Fax:716-961-3706
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3337071363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
000560781003OtherBCBS
000560781003OtherBCBS