Provider Demographics
NPI:1184700874
Name:VANDOREN, LAURA E (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:VANDOREN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 W 38TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1188
Mailing Address - Country:US
Mailing Address - Phone:512-324-8670
Mailing Address - Fax:512-380-7531
Practice Address - Street 1:911 W 38TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1188
Practice Address - Country:US
Practice Address - Phone:512-324-8670
Practice Address - Fax:512-380-7531
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125434363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200232830AMedicaid
IN200232830AMedicaid
INS91113Medicare UPIN