Healthcare Provider Details

I. General information

NPI: 1083834287
Provider Name (Legal Business Name): LAUREE JEAN FORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 VICTORIA LANE
HARLINGEN TX
78550
US

IV. Provider business mailing address

2607 CHARLOTTE CIR
PHARR TX
78577-6835
US

V. Phone/Fax

Practice location:
  • Phone: 956-425-9600
  • Fax:
Mailing address:
  • Phone: 956-566-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number714930
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: