Provider Demographics
NPI:1326477084
Name:FODOR, LAURA (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:FODOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4967 CROOKS RD
Mailing Address - Street 2:STE 130
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5801
Mailing Address - Country:US
Mailing Address - Phone:248-952-1601
Mailing Address - Fax:248-952-1614
Practice Address - Street 1:3851 WEST RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2350
Practice Address - Country:US
Practice Address - Phone:734-675-5100
Practice Address - Fax:734-692-5787
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2015-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704266295363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health