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General NPI Number Information
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NPI Number | 1962087726
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Entity Type | Individual
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Provider Name | LAURA LEE HENRIKSON AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/13/2021
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 9201 E MOUNTAIN VIEW RD STE 220
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-5172
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Country | US
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Telephone | 480-271-3774
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Fax |
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Provider Business Mailing Address
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Address Line | 42 SAYWARD LN
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City | PORT LUDLOW
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State | WA
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Zip | 98365-9640
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Country | US
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Telephone | 646-753-1695
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP61120717
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP61120717
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License Number State | WA
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