Provider Demographics
NPI:1417401118
Name:VANDER KELEN, LAURA DEBRA (LM, CPM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DEBRA
Last Name:VANDER KELEN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LM,CPM
Mailing Address - Street 1:6931 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2502
Mailing Address - Country:US
Mailing Address - Phone:727-485-3363
Mailing Address - Fax:
Practice Address - Street 1:215 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5307
Practice Address - Country:US
Practice Address - Phone:813-685-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW335176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife