Provider Demographics
NPI:1992079727
Name:KELLIHER, LAURA ORTMAN (CPNP, APRN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ORTMAN
Last Name:KELLIHER
Suffix:
Gender:F
Credentials:CPNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 UNION ST
Mailing Address - Street 2:SBHC
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1314
Mailing Address - Country:US
Mailing Address - Phone:781-599-0276
Mailing Address - Fax:
Practice Address - Street 1:269 UNION ST
Practice Address - Street 2:SBHC
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1314
Practice Address - Country:US
Practice Address - Phone:781-599-3925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2264432363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics