Provider Demographics
NPI:1982661039
Name:MAW, LAURA CROFT (DNP, APRN-C, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CROFT
Last Name:MAW
Suffix:
Gender:F
Credentials:DNP, APRN-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 W PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4753
Mailing Address - Country:US
Mailing Address - Phone:801-376-0874
Mailing Address - Fax:888-607-2618
Practice Address - Street 1:2874 W PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4753
Practice Address - Country:US
Practice Address - Phone:801-376-0874
Practice Address - Fax:888-607-2618
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT213838-8900363LF0000X
UT213838-4405364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1982661039Medicaid
UTD6076Medicaid
UT000060789Medicare Oscar/Certification
000060789Medicare PIN
UTD6076Medicaid