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General NPI Number Information
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NPI Number | 1285955872
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Entity Type | Organization
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Legal Business Name | DEMING PEDIATRICS PLLC
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 1300 N VIRGINIA ST SUITE 111
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City | PORT LAVACA
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State | TX
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Zip | 77979-2509
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Country | US
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Telephone | 361-553-6844
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Fax | 361-553-7314
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Provider Business Mailing Address
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Address Line | 1300 N VIRGINIA ST SUITE 111
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City | PORT LAVACA
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State | TX
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Zip | 77979-2509
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Country | US
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Telephone | 361-553-6844
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Fax | 361-553-7314
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Authorized Official
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Title or Position | OWNER
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Name | LAURA M DEMING
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Credential | PNP
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Telephone | 361-553-6844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 587712
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License Number State | TX
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