Provider Demographics
NPI:1437797321
Name:FANGMAN, LAURA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:FANGMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 W 8TH ST OFC
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45204-2052
Mailing Address - Country:US
Mailing Address - Phone:513-357-2809
Mailing Address - Fax:
Practice Address - Street 1:2411 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-1001
Practice Address - Country:US
Practice Address - Phone:513-363-4118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH330565163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse