Provider Demographics
NPI:1346542065
Name:ZANG, LAURA MATTSON (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MATTSON
Last Name:ZANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:LOUISE
Other - Last Name:MATTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:26650 EUREKA RD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4835
Mailing Address - Country:US
Mailing Address - Phone:734-941-4991
Mailing Address - Fax:734-941-4919
Practice Address - Street 1:2500 HAMLIN DR
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2348
Practice Address - Country:US
Practice Address - Phone:313-561-5100
Practice Address - Fax:313-565-0309
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704096784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H24998OtherBCBS
MI1346542065Medicaid
MI0H24998OtherBCBS