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General NPI Number Information
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NPI Number | 1710799705
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Entity Type | Individual
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Provider Name | LAURIE GENDRON MARTIN APRN
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Gender | Female
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Dates
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Enumeration Date | 01/25/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 4835 LBJ FWY STE 900
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City | DALLAS
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State | TX
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Zip | 75244-6001
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Country | US
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Telephone | 469-420-5508
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Fax | 469-619-9690
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Provider Business Mailing Address
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Address Line | 34 CRYSTAL LAKE LN
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City | THE WOODLANDS
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State | TX
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Zip | 77380-1856
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Country | US
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Telephone | 214-793-8835
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1189134
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License Number State | TX
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