Healthcare Provider Details

I. General information

NPI: 1659357069
Provider Name (Legal Business Name): LAURA ELLEN LAASE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 SPENCER HWY
PASADENA TX
77504-1202
US

IV. Provider business mailing address

PO BOX 200993
HOUSTON TX
77216-0993
US

V. Phone/Fax

Practice location:
  • Phone: 713-359-2000
  • Fax: 713-359-1004
Mailing address:
  • Phone: 281-784-1111
  • Fax: 281-784-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA03148
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: