Healthcare Provider Details

I. General information

NPI: 1518545524
Provider Name (Legal Business Name): LAURA N GAUTREAU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 10TH AVE STE 320
COLUMBUS GA
31901-3711
US

IV. Provider business mailing address

2000 10TH AVE STE 320
COLUMBUS GA
31901-3711
US

V. Phone/Fax

Practice location:
  • Phone: 706-366-3850
  • Fax: 762-266-1030
Mailing address:
  • Phone: 706-366-3850
  • Fax: 762-266-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN297126
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: