Basic Information
| Provider Information | |||||||||
| NPI: | 1538411749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAISE | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 707 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109402650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453337575 | ||||||||
| FaxNumber: | 8453334663 | ||||||||
| Practice Location | |||||||||
| Address1: | 258 HIGH AVE | ||||||||
| Address2: | |||||||||
| City: | NYACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109602407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453482550 | ||||||||
| FaxNumber: | 8453489821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2012 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 709342-1 | NY | N | Nursing Service Providers | Registered Nurse | 367A00000X | MW010286 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 176B00000X | F001647-1 | NY | Y | Other Service Providers | Midwife |
No ID Information.