Provider Demographics
NPI:1134622491
Name:BAINBRIDGE, LAURA (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BAINBRIDGE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:BAIGRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1333 W 5TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2752
Mailing Address - Country:US
Mailing Address - Phone:307-675-2649
Mailing Address - Fax:
Practice Address - Street 1:1435 BURTON ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2723
Practice Address - Country:US
Practice Address - Phone:307-675-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9324385363LF0000X
WY47616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily