Provider Demographics
NPI:1346209673
Name:GRUNDY, LAURA ELIZABETH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:GRUNDY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BUCKINGHAM RD STE 110
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5850
Mailing Address - Country:US
Mailing Address - Phone:972-235-3804
Mailing Address - Fax:
Practice Address - Street 1:1001 BUCKINGHAM RD STE 110
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5850
Practice Address - Country:US
Practice Address - Phone:972-235-3804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N9196OtherBCBS
TX176455702Medicaid
TXP00479773OtherRAILROAD
TX176455701Medicaid
TX8D9871Medicare PIN
TX176455701Medicaid
Q52780Medicare UPIN