Basic Information
| Provider Information | |||||||||
| NPI: | 1952620262 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YACINO | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 PARKER RD | ||||||||
| Address2: | |||||||||
| City: | NARROWSBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127646200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184412835 | ||||||||
| FaxNumber: | 7188056041 | ||||||||
| Practice Location | |||||||||
| Address1: | 13020 89TH RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114183301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184412835 | ||||||||
| FaxNumber: | 7188056041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2010 | ||||||||
| LastUpdateDate: | 06/01/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 469812-1 | NY | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 469812-1 | 01 | NY | NYS REGISTERED PROFESSIONAL NURSE LICENSE # | OTHER |