Provider Demographics
NPI:1659384931
Name:ANDERSON, LAURA C (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:C
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:3-3367 KUHIO HWY STE 200
Mailing Address - Street 2:KAUAI CBOC
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1034
Mailing Address - Country:US
Mailing Address - Phone:808-246-0497
Mailing Address - Fax:
Practice Address - Street 1:3-3367 KUHIO HWY STE 200
Practice Address - Street 2:KAUAI CBOC
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1034
Practice Address - Country:US
Practice Address - Phone:808-246-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO3743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily