Provider Demographics
NPI:1952661290
Name:DENNISON, LAUREL A (CNA)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:A
Last Name:DENNISON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 GOVERNORS HOUSE DR SW
Mailing Address - Street 2:APT 503
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-3219
Mailing Address - Country:US
Mailing Address - Phone:256-714-4189
Mailing Address - Fax:
Practice Address - Street 1:4611 GOVERNORS HOUSE DR SW
Practice Address - Street 2:APT 503
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-3219
Practice Address - Country:US
Practice Address - Phone:256-714-4189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9503434376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide