Provider Demographics
NPI:1639709660
Name:PENNINGTON, LAURA DIANE (CNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DIANE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 WALTER ST SE UNIT B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3595
Mailing Address - Country:US
Mailing Address - Phone:816-778-6067
Mailing Address - Fax:
Practice Address - Street 1:UNMH
Practice Address - Street 2:2211 LOMAS BOULEVARD NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:816-778-6067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM57705363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care