=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861217937
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA ANN SOWERS FNP -BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2024
-----------------------------------------------------
Last Update Date | 01/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 851 JACKSON ST
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45331-1277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-670-2870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3404 OTTAWA CIR
-----------------------------------------------------
City | PIQUA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45356-9785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-570-6681
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0037834
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------