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NPI Code Detail

MEDICARE: LAURENT E. O. AVONDSTONDT NP

MEDICARE: LAURENT E. O. AVONDSTONDT NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner200350144NPOR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053302265
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURENT E. O. AVONDSTONDT NP
Provider Business Mailing Address
First Line : PSC 482 BOX 1600
Second Line :
City : FPO
State : AP
Zip : 96362-9998
Country : US
Telephone Number : 315-643-7977
Fax Number :
Provider Business Practice Location Address
First Line : 3710 SW US VETERANS HOSPITAL RD
Second Line :
City : PORTLAND
State : OR
Zip : 97239-2964
Country : US
Telephone Number : 503-220-8262
Fax Number : 503-731-1035
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2005
Last Update Date : 07/12/2011

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