Healthcare Provider Details

I. General information

NPI: 1033440425
Provider Name (Legal Business Name): LAURA ELIZABETH MCVAY GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST RM 8435
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

1200 N STATE ST RM 8435
LOS ANGELES CA
90033-1029
US

V. Phone/Fax

Practice location:
  • Phone: 818-317-5138
  • Fax:
Mailing address:
  • Phone: 818-317-5138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number19552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: