Provider Demographics
NPI:1760950661
Name:LAURA NEPVEU, MD, LLC
Entity Type:Organization
Organization Name:LAURA NEPVEU, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEPVEU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-481-4750
Mailing Address - Street 1:15115 SW SEQUOIA PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7156
Mailing Address - Country:US
Mailing Address - Phone:503-481-4750
Mailing Address - Fax:503-244-0995
Practice Address - Street 1:15115 SW SEQUOIA PKWY STE 170
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7156
Practice Address - Country:US
Practice Address - Phone:503-481-4750
Practice Address - Fax:503-244-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR073200Medicaid