Provider Demographics
NPI:1265636443
Name:ENGBRETSON, LAURA LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LYNNE
Last Name:ENGBRETSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2595 CENTRAL AVENUE
Mailing Address - Street 2:CHRIST COMMUNITY HEALTH SERVICES INC
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-260-8551
Mailing Address - Fax:901-260-8590
Practice Address - Street 1:1211 UNION AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6638
Practice Address - Country:US
Practice Address - Phone:901-271-0330
Practice Address - Fax:901-271-0399
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2012-04-26
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Provider Licenses
StateLicense IDTaxonomies
TN42174207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514711Medicaid
TN1514711Medicaid