Healthcare Provider Details

I. General information

NPI: 1477541985
Provider Name (Legal Business Name): LAURA E. RODRIGUEZ MSN,FNP,GNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MEDICAL CENTER DR SUITE 3
ROHNERT PARK CA
94928-2924
US

IV. Provider business mailing address

2600 N FITCH MOUNTAIN RD
HEALDSBURG CA
95448-4526
US

V. Phone/Fax

Practice location:
  • Phone: 707-547-4684
  • Fax:
Mailing address:
  • Phone: 707-433-9739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number361567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: