Basic Information
| Provider Information | |||||||||
| NPI: | 1720190937 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAU | ||||||||
| FirstName: | GERALDINE | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | ARANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 GREENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038186130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034473500 | ||||||||
| FaxNumber: | 6034475568 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 GREENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038186130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034473500 | ||||||||
| FaxNumber: | 6034475568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 046872-23-03 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 30342532 | 05 | NH | MEDICAID | 2745380 | 01 | NH | CIGNA | OTHER |