Provider Demographics
NPI:1417488347
Name:CARDWELL, LAURA LAVINIA (DNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LAVINIA
Last Name:CARDWELL
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 HANCOCK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-5078
Mailing Address - Country:US
Mailing Address - Phone:928-763-7111
Mailing Address - Fax:928-763-7172
Practice Address - Street 1:809 HANCOCK RD STE 1
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5078
Practice Address - Country:US
Practice Address - Phone:928-763-7111
Practice Address - Fax:928-763-7172
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60758521363LP0808X
AZAP11094363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health