Healthcare Provider Details

I. General information

NPI: 1720337561
Provider Name (Legal Business Name): LAURA PAYNE STEELE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA LEIGH PAYNE

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 MEDICAL DR
SAN ANTONIO TX
78229-4403
US

IV. Provider business mailing address

PO BOX 87
SAN ANTONIO TX
78291-0087
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-8144
  • Fax: 210-358-8536
Mailing address:
  • Phone: 210-358-9174
  • Fax: 210-358-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number744030
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: