Provider Demographics
NPI:1043610355
Name:DUKE, LAURA MARGARET
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:MARGARET
Last Name:DUKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 N 55TH AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1321
Mailing Address - Country:US
Mailing Address - Phone:623-931-5001
Mailing Address - Fax:
Practice Address - Street 1:7800 N 55TH AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1321
Practice Address - Country:US
Practice Address - Phone:623-931-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7285363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics