Provider Demographics
NPI:1568779783
Name:THOMAS, LAURA LEE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-1949
Mailing Address - Country:US
Mailing Address - Phone:435-635-9444
Mailing Address - Fax:435-635-8148
Practice Address - Street 1:11 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-1949
Practice Address - Country:US
Practice Address - Phone:435-635-9444
Practice Address - Fax:435-635-8148
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1963664-8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1963648900Medicare Oscar/Certification