Provider Demographics
NPI:1942699152
Name:PENAFIEL, LAURA (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PENAFIEL
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:SAN ELIZARIO
Mailing Address - State:TX
Mailing Address - Zip Code:79849-0346
Mailing Address - Country:US
Mailing Address - Phone:915-319-9100
Mailing Address - Fax:
Practice Address - Street 1:2931 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2409
Practice Address - Country:US
Practice Address - Phone:915-562-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126961363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology