Provider Demographics
NPI:1790042869
Name:LUDWIG, LAURA YVONNE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:YVONNE
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:YVONNE
Other - Last Name:LUDWIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:1149 E BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4162
Mailing Address - Country:US
Mailing Address - Phone:602-944-1674
Mailing Address - Fax:
Practice Address - Street 1:1149 E BELMONT AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4162
Practice Address - Country:US
Practice Address - Phone:602-944-1674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP007865164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse