Provider Demographics
NPI:1184044844
Name:BROMAGE, LAURA M (RN, NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:BROMAGE
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:N
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP
Mailing Address - Street 1:701 E EL CAMINO REAL FL 3
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2833
Mailing Address - Country:US
Mailing Address - Phone:650-934-7616
Mailing Address - Fax:
Practice Address - Street 1:701 E EL CAMINO REAL FL 3
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2833
Practice Address - Country:US
Practice Address - Phone:650-934-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000105363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health