Basic Information
| Provider Information | |||||||||
| NPI: | 1013668060 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAURENT | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 UNIVERSITY PLZ STE 205 | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076016208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018333000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 92 SUMMIT AVE | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076011263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013736522 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2022 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 26NJ01210000 | NJ | N | Nursing Service Providers | Registered Nurse | 163W00000X | 26NR10246100 | NJ | N | Nursing Service Providers | Registered Nurse | 163WM0705X | 26NR10246100 | NJ | N | Nursing Service Providers | Registered Nurse | Medical-Surgical | 363L00000X | 26NJ01210000 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.