Provider Demographics
NPI:1174642763
Name:RODRIGUEZ, LAURA (APN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8913 DOUBLETREE DR S
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9384
Mailing Address - Country:US
Mailing Address - Phone:219-669-8191
Mailing Address - Fax:
Practice Address - Street 1:5800 BROADWAY
Practice Address - Street 2:SUITE A-J
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2601
Practice Address - Country:US
Practice Address - Phone:219-884-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28141035A364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine