Healthcare Provider Details

I. General information

NPI: 1851952832
Provider Name (Legal Business Name): LAURA MAE EMERY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA MAE TERRELL

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N MAIN ST # 304
CROWN POINT IN
46307-1877
US

IV. Provider business mailing address

2400 SAGAMORE PKWY S
LAFAYETTE IN
47905-5116
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-1900
  • Fax: 574-546-1999
Mailing address:
  • Phone: 765-772-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019012949
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009241A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: