Provider Demographics
NPI:1477541985
Name:RODRIGUEZ, LAURA E (MSN,FNP,GNP-BC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSN,FNP,GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N FITCH MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-4526
Mailing Address - Country:US
Mailing Address - Phone:707-433-9739
Mailing Address - Fax:
Practice Address - Street 1:1450 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 3
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2924
Practice Address - Country:US
Practice Address - Phone:707-547-4684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMR1151137OtherDEA
CAQ313999Medicare UPIN