Provider Demographics
NPI:1922304435
Name:MOLYNEAUX, LAURA (RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MOLYNEAUX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27176 HAGGERTY ROAD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:248-799-8300
Mailing Address - Fax:
Practice Address - Street 1:27175 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3626
Practice Address - Country:US
Practice Address - Phone:248-799-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WARN00128081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program