Provider Demographics
NPI:1073614830
Name:PAVELKA, LAURA MARIE (ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARIE
Last Name:PAVELKA
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 HEATHERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2695
Mailing Address - Country:US
Mailing Address - Phone:214-621-2625
Mailing Address - Fax:214-389-7435
Practice Address - Street 1:630 N COIT RD
Practice Address - Street 2:SUITE 2200
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3700
Practice Address - Country:US
Practice Address - Phone:214-389-7355
Practice Address - Fax:214-389-7435
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX693670363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX693670OtherNP LICENSE NUMBER