Provider Demographics
NPI:1265744361
Name:PEDERSEN FOREMAN, LAURA N (GNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:N
Last Name:PEDERSEN FOREMAN
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:N
Other - Last Name:PEDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GNP
Mailing Address - Street 1:2920 EL DORADO BLVD APT 213
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5796
Mailing Address - Country:US
Mailing Address - Phone:281-413-9676
Mailing Address - Fax:409-316-9306
Practice Address - Street 1:3272 BROADWAY ST STE 19
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4502
Practice Address - Country:US
Practice Address - Phone:281-413-9676
Practice Address - Fax:832-569-2111
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118826363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology