Provider Demographics
NPI:1639470487
Name:MCLAIN, LAURA (BSN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:WISSEHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:339 CONSORT DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4439
Mailing Address - Country:US
Mailing Address - Phone:636-386-9224
Mailing Address - Fax:636-200-4243
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:DEPT. OF ANESTHESIA
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-4687
Practice Address - Fax:636-200-4243
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011002328367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600290026Medicare PIN