Healthcare Provider Details

I. General information

NPI: 1184700874
Provider Name (Legal Business Name): LAURA E. VANDOREN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W 38TH ST SUITE 202
AUSTIN TX
78705-1188
US

IV. Provider business mailing address

911 W 38TH ST SUITE 202
AUSTIN TX
78705-1188
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-8670
  • Fax: 512-380-7531
Mailing address:
  • Phone: 512-324-8670
  • Fax: 512-380-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP125434
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: