Provider Demographics
NPI:1225590193
Name:ANSEL, LAURA EDELTRAUT
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:EDELTRAUT
Last Name:ANSEL
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 1:8357 STELLING DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-8410
Mailing Address - Country:US
Mailing Address - Phone:757-478-2601
Mailing Address - Fax:
Practice Address - Street 1:8357 STELLING DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-8410
Practice Address - Country:US
Practice Address - Phone:757-478-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002094429164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse