Provider Demographics
NPI:1639627102
Name:HEACOCK, LAURA BROWN (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BROWN
Last Name:HEACOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 W STATE ST
Mailing Address - Street 2:BOX 60
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2554
Mailing Address - Country:US
Mailing Address - Phone:215-345-2605
Mailing Address - Fax:215-345-2031
Practice Address - Street 1:599 W STATE ST
Practice Address - Street 2:SUITE 307
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2567
Practice Address - Country:US
Practice Address - Phone:215-345-2605
Practice Address - Fax:215-345-2031
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP015434363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health