Provider Demographics
NPI:1114205572
Name:WORLEY, LAURA ESPERANZA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ESPERANZA
Last Name:WORLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ESPERANZA
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8333 NAAB RD STE 250
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1983
Mailing Address - Country:US
Mailing Address - Phone:317-396-1300
Mailing Address - Fax:317-924-8472
Practice Address - Street 1:1115 RONALD REAGAN PKWY STE 148
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6913
Practice Address - Country:US
Practice Address - Phone:317-396-1300
Practice Address - Fax:317-217-2144
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99048212A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000738425OtherANTHEM PIN
IN000000738425OtherANTHEM PIN
INM400052695Medicare PIN