Provider Demographics
NPI:1801382320
Name:MAAG, LAURA (CNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MAAG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BYERS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3684
Mailing Address - Country:US
Mailing Address - Phone:937-866-2494
Mailing Address - Fax:937-866-8494
Practice Address - Street 1:415 BYERS RD STE 300
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342
Practice Address - Country:US
Practice Address - Phone:937-866-2494
Practice Address - Fax:937-866-8494
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.380043363LA2200X
OHAPRN.CNP.023105363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0308820Medicaid