Provider Demographics
NPI:1245393164
Name:FREMGEN, LAURA S (CPM, LM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:FREMGEN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 RICHCREEK RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1845
Mailing Address - Country:US
Mailing Address - Phone:512-450-0908
Mailing Address - Fax:512-206-0936
Practice Address - Street 1:1707 RICHCREEK RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1845
Practice Address - Country:US
Practice Address - Phone:512-450-0908
Practice Address - Fax:512-206-0936
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01008176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01090002OtherCPM NUMBER
TX01008OtherLISCENSE NUMBER