Healthcare Provider Details

I. General information

NPI: 1396812533
Provider Name (Legal Business Name): LAURA CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 SW 4TH STREET
REDMOND OR
97756-0535
US

IV. Provider business mailing address

PO BOX 2042
REDMOND OR
97756-0535
US

V. Phone/Fax

Practice location:
  • Phone: 541-526-5801
  • Fax: 541-526-5913
Mailing address:
  • Phone: 541-526-5801
  • Fax: 541-526-5913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number80046130N1
License Number StateOR

VIII. Authorized Official

Name: LAURA J CHESHIRE
Title or Position: PRESIDENT/PROVIDER
Credential: FNP
Phone: 541-526-5801