Provider Demographics
NPI:1417438425
Name:DAIGLE, LAURA (MSN, APRN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 CIBOLO VALLEY DR STE 221
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3834
Mailing Address - Country:US
Mailing Address - Phone:210-314-1820
Mailing Address - Fax:830-268-4713
Practice Address - Street 1:580 CIBOLO VALLEY DR STE 221
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108
Practice Address - Country:US
Practice Address - Phone:210-314-1820
Practice Address - Fax:830-268-4713
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX759168163W00000X
TXAP139325363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173913801Medicaid