Healthcare Provider Details

I. General information

NPI: 1073614830
Provider Name (Legal Business Name): LAURA MARIE PAVELKA ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N COIT RD SUITE 2200
RICHARDSON TX
75080-3700
US

IV. Provider business mailing address

3249 HEATHERBROOK LN
RICHARDSON TX
75082-2695
US

V. Phone/Fax

Practice location:
  • Phone: 214-389-7355
  • Fax: 214-389-7435
Mailing address:
  • Phone: 214-621-2625
  • Fax: 214-389-7435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number693670
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: