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NPI Code Detail

MEDICARE: LAURA D VANDERMARTIN RN

MEDICARE:   LAURA D VANDERMARTIN  RN
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
1163WC0400XCase Management Registered Nurse700025TX

General Provider Information

NPI Number : 1902876592
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA D VANDERMARTIN RN
Provider Business Mailing Address
First Line : 122A ILIAMNA AVE
Second Line :
City : FT RICHARDSON
State : AK
Zip : 99505-1011
Country : US
Telephone Number : 907-384-1408
Fax Number :
Provider Business Practice Location Address
First Line : TROOP MEDICAL CLINIC
Second Line : 724 POSTAL SERVICE LOOP #7499
City : FT RICHARDSON
State : AK
Zip : 99505
Country : US
Telephone Number : 907-384-0600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 07/08/2007

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Directions to “ LAURA D VANDERMARTIN RN” Practice Location

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