Healthcare Provider Details

I. General information

NPI: 1962665372
Provider Name (Legal Business Name): LAURA CUMMINGS GRIFFIN DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 NORTH PINE RD
OLLA LA
71465
US

IV. Provider business mailing address

1136 NORTH PINE RD
OLLA LA
71465
US

V. Phone/Fax

Practice location:
  • Phone: 318-495-7979
  • Fax: 318-795-3229
Mailing address:
  • Phone: 318-495-7979
  • Fax: 318-495-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO5514
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: