Provider Demographics
NPI:1245349356
Name:O'BANNON, LAURA LYNN (ARNP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LYNN
Last Name:O'BANNON
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Gender:F
Credentials:ARNP
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Mailing Address - Street 1:321 EASY ST
Mailing Address - Street 2:#8
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-3768
Mailing Address - Country:US
Mailing Address - Phone:650-625-1784
Mailing Address - Fax:650-852-3473
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:#111C
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-852-3473
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA442237363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner