Basic Information
| Provider Information | |||||||||
| NPI: | 1982872743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELLER | ||||||||
| FirstName: | LAUREEN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 158 N MAIN ST | ||||||||
| Address2: | PO BOX 299 | ||||||||
| City: | FLORIDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109211133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456511412 | ||||||||
| FaxNumber: | 8456511512 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 DUNNING RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109402216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453444477 | ||||||||
| FaxNumber: | 8453446072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2008 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | F302823 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.