Healthcare Provider Details

I. General information

NPI: 1194545111
Provider Name (Legal Business Name): ANTOINELLE LAURON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 SHERMAN WAY STE 250
VAN NUYS CA
91405-2284
US

IV. Provider business mailing address

14600 SHERMAN WAY STE 250
VAN NUYS CA
91405-2284
US

V. Phone/Fax

Practice location:
  • Phone: 818-998-6600
  • Fax:
Mailing address:
  • Phone: 818-998-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: