Provider Demographics
NPI:1750315099
Name:STRADER, LAURA BRAWLEY (CFNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BRAWLEY
Last Name:STRADER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 CROWE LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-7264
Mailing Address - Country:US
Mailing Address - Phone:423-623-0653
Mailing Address - Fax:423-625-8264
Practice Address - Street 1:1829 CROWE LN
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-7264
Practice Address - Country:US
Practice Address - Phone:423-623-0653
Practice Address - Fax:423-625-8264
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3496736Medicaid
TN3496736Medicaid