Provider Demographics
NPI:1801219746
Name:MANN, LAURA KATE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KATE
Last Name:MANN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1639
Mailing Address - Country:US
Mailing Address - Phone:706-296-3406
Mailing Address - Fax:
Practice Address - Street 1:617 SAXONY PL
Practice Address - Street 2:SUITE 103
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2797
Practice Address - Country:US
Practice Address - Phone:706-296-3406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA826096163W00000X
CA2011367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse