Healthcare Provider Details

I. General information

NPI: 1245965235
Provider Name (Legal Business Name): LAURA ELAINE DEFREITAS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WILDWOOD DR STE 105
GEORGETOWN TX
78633-1344
US

IV. Provider business mailing address

1801 CHERRY GLADE TRL
GEORGETOWN TX
78628-6949
US

V. Phone/Fax

Practice location:
  • Phone: 512-763-4060
  • Fax: 512-863-4088
Mailing address:
  • Phone: 209-985-5979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1088238
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: