Provider Demographics
NPI:1689174500
Name:SMITH, LAURA LOUISE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LOUISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N RHOMBERG ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-1926
Mailing Address - Country:US
Mailing Address - Phone:512-525-3469
Mailing Address - Fax:
Practice Address - Street 1:800 N RHOMBERG ST APT 3
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-1926
Practice Address - Country:US
Practice Address - Phone:512-525-3469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant