Provider Demographics
NPI:1245411784
Name:PEZZOPANE, LAURA K (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:PEZZOPANE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:KATHERINE
Other - Last Name:LAROSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2101
Mailing Address - Fax:614-293-9155
Practice Address - Street 1:410 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-2101
Practice Address - Fax:614-293-9155
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.09726363LA2200X
OHCOA 09726363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2815556Medicaid