Provider Demographics
NPI:1245834597
Name:LETELLIER, LAWRENCE (MSN,APRN,FNP-C)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:LETELLIER
Suffix:
Gender:M
Credentials:MSN,APRN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 AUSTIN HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-1860
Mailing Address - Country:US
Mailing Address - Phone:210-436-8400
Mailing Address - Fax:833-452-1052
Practice Address - Street 1:9910 W LOOP 1604 N STE 128
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-5610
Practice Address - Country:US
Practice Address - Phone:210-455-6253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily