Healthcare Provider Details

I. General information

NPI: 1184044844
Provider Name (Legal Business Name): LAURA M BROMAGE RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA N MARSHALL RN, NP

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E EL CAMINO REAL FL 3
MOUNTAIN VIEW CA
94040-2833
US

IV. Provider business mailing address

701 E EL CAMINO REAL FL 3
MOUNTAIN VIEW CA
94040-2833
US

V. Phone/Fax

Practice location:
  • Phone: 650-934-7616
  • Fax:
Mailing address:
  • Phone: 650-934-7616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95000105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: