Provider Demographics
NPI:1619275120
Name:GREENHAM, LAURA EILEEN (APRN CNM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:EILEEN
Last Name:GREENHAM
Suffix:
Gender:F
Credentials:APRN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 SW TOPEKA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66612-1602
Mailing Address - Country:US
Mailing Address - Phone:785-232-6950
Mailing Address - Fax:785-232-4722
Practice Address - Street 1:1412 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1529
Practice Address - Country:US
Practice Address - Phone:785-232-6950
Practice Address - Fax:785-232-4722
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-64099-012367A00000X
KSG4099367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife