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General NPI Number Information
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NPI Number | 1073614830
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Entity Type | Individual
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Provider Name | LAURA MARIE PAVELKA ANP-C
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 630 N COIT RD SUITE 2200
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City | RICHARDSON
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State | TX
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Zip | 75080-3700
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Country | US
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Telephone | 214-389-7355
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Fax | 214-389-7435
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Provider Business Mailing Address
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Address Line | 3249 HEATHERBROOK LN
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City | RICHARDSON
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State | TX
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Zip | 75082-2695
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Country | US
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Telephone | 214-621-2625
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Fax | 214-389-7435
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 693670
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License Number State | TX
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