Provider Demographics
NPI:1548774631
Name:GOLDSCHRAFE, LAURA M (CNM, WHNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:GOLDSCHRAFE
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-3987
Mailing Address - Fax:
Practice Address - Street 1:4875 SUNRISE HWY STE 200
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716
Practice Address - Country:US
Practice Address - Phone:631-444-3987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
F001811-1176B00000X
NY421322363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No176B00000XOther Service ProvidersMidwife