Active NPI
Lauren Elizabeth-Anne Premo
- Registered Nurse
- Malone, NY
National Provider Identifier
1891389896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 753627
- Practice address
- 15 4TH St
Malone, NY 12953-1340 - Phone
- (315) 600-0279
- NPI assigned
- Feb 22, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 753627 | NY | Primary |
Addresses
Primary practice location
15 4TH St
Malone, NY 12953-1340
Mailing address
15 4TH St
Malone, NY 12953-1340
Phone (518) 481-8160
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Malone |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 753627 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613952000000",
"number": "1891389896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 4TH ST",
"city": "MALONE",
"state": "NY",
"postal_code": "129531340",
"telephone_number": "518-481-8160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 4TH ST",
"city": "MALONE",
"state": "NY",
"postal_code": "129531340",
"telephone_number": "315-600-0279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PREMO",
"first_name": "LAUREN",
"middle_name": "ELIZABETH-ANNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-22",
"last_updated": "2021-02-22",
"certification_date": "2021-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "753627",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Malone",
"affiliation": "N",
"address_1": "15 4th St",
"city": "Malone",
"state": "NY",
"country_code": "US",
"postal_code": "129531340",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Malone, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.