Individual
LAURIE DELORES MARIE MANSFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
90 HIDEAWAY LN, BROCKPORT, NY 14420-9365
(585) 392-5190
Mailing address
90 HIDEAWAY LN, BROCKPORT, NY 14420-9365
(585) 392-5190
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
Primary
515392
NY
163WP0200X
Pediatric Registered Nurse
515392
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02065209
—
NY
Enumeration date
07/16/2007
Last updated
07/16/2007
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