MEDICARE: DR. LAURA JEAN AVNE DPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	645	NV

General Provider Information

NPI Number	:	1932415866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA JEAN AVNE DPA

Provider Business Mailing Address
First Line	:	608 BAYSVILLE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-4414
Country	:	US
Telephone Number	:	702-838-5429
Fax Number	:

Provider Business Practice Location Address
First Line	:	5552 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7694
Country	:	US
Telephone Number	:	702-641-8255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	08/30/2010

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