Individual
DANIELLE M LARUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
114 CASSIDY RD, HERMON, NY 13652-3114
(315) 347-1386
Mailing address
PO BOX 502, RUSSELL, NY 13684-0502
(315) 347-1386
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
265608-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02570414
—
NY
Enumeration date
11/21/2007
Last updated
11/21/2007
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