Provider Demographics
NPI:1518983865
Name:NEAL, LAURA D (CNM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:NEAL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARK WEST BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320
Mailing Address - Country:US
Mailing Address - Phone:330-869-9777
Mailing Address - Fax:300-865-6011
Practice Address - Street 1:1 PARK WEST BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320
Practice Address - Country:US
Practice Address - Phone:330-869-9777
Practice Address - Fax:300-865-6011
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367A00000X
OHRN259831NM07461367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000509180OtherANTHEM
OH2511277Medicaid
OH7803663OtherAETNA
OHNENM03052Medicare PIN
OH7803663OtherAETNA
OH2511277Medicaid