Provider Demographics
NPI:1164275384
Name:NEELY, LAURA HELLEN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:HELLEN
Last Name:NEELY
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:PO BOX 6888
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-6888
Mailing Address - Country:US
Mailing Address - Phone:707-496-8499
Mailing Address - Fax:707-497-6777
Practice Address - Street 1:350 E ST STE 403
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0352
Practice Address - Country:US
Practice Address - Phone:707-496-8499
Practice Address - Fax:707-497-6777
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124700001253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care