Provider Demographics
NPI:1184159741
Name:COLE, LAURA (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W SURREY AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1824
Mailing Address - Country:US
Mailing Address - Phone:602-677-5399
Mailing Address - Fax:
Practice Address - Street 1:18275 N 59TH AVE STE K162
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1260
Practice Address - Country:US
Practice Address - Phone:602-755-0800
Practice Address - Fax:602-560-2721
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN159084163W00000X
AZAP10019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse