MEDICARE: LAURA CATHERINE FORD CNP

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
1	363L00000X	Nurse Practitioner	4704134722	MI
2	363LW0102X	Women's Health Nurse Practitioner	4704134722	MI

Other Identifiers

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

General Provider Information

NPI Number	:	1326047358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA CATHERINE FORD CNP

Provider Business Mailing Address
First Line	:	52375 N MAIN ST
Second Line	:
City	:	MATTAWAN
State	:	MI
Zip	:	49071-9332
Country	:	US
Telephone Number	:	269-668-3348
Fax Number	:	269-668-7702

Provider Business Practice Location Address
First Line	:	52375 N MAIN ST
Second Line	:
City	:	MATTAWAN
State	:	MI
Zip	:	49071-9332
Country	:	US
Telephone Number	:	269-668-3348
Fax Number	:	269-668-7702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	11/19/2014

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Directions to “ LAURA CATHERINE FORD CNP” Practice Location

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