Provider Demographics
NPI:1396325759
Name:REEDY, LAURA JANEL (CAA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JANEL
Last Name:REEDY
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JANEL
Other - Last Name:URBANOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1221 E BROADWAY APT 408
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-2541
Mailing Address - Country:US
Mailing Address - Phone:404-316-9776
Mailing Address - Fax:
Practice Address - Street 1:1850 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4990
Practice Address - Country:US
Practice Address - Phone:812-944-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INAPPLIED367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant