Healthcare Provider Details

I. General information

NPI: 1740884550
Provider Name (Legal Business Name): LAURA LEE CANADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 SPRING CYPRESS RD STE 500
CYPRESS TX
77429-7578
US

IV. Provider business mailing address

14706 KELSEY VISTA DR STE 1B
CYPRESS TX
77433-6825
US

V. Phone/Fax

Practice location:
  • Phone: 281-650-1218
  • Fax:
Mailing address:
  • Phone: 281-713-9641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1033240
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number607038
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: