Provider Demographics
NPI:1710061171
Name:ANDERSEN, LAURA ANN (PAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:HIKEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15436 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022
Mailing Address - Country:US
Mailing Address - Phone:602-995-0234
Mailing Address - Fax:602-995-0234
Practice Address - Street 1:521 W THOMAS RD FL 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4241
Practice Address - Country:US
Practice Address - Phone:602-254-0390
Practice Address - Fax:888-846-8757
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3022OtherLICENSE
MA0717845OtherAHCCCS