Provider Demographics
NPI:1700608437
Name:MAHON, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MAHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4935 WOODMAN PARK DR APT 12
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-1149
Mailing Address - Country:US
Mailing Address - Phone:231-714-0790
Mailing Address - Fax:
Practice Address - Street 1:4935 WOODMAN PARK DR APT 12
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-1149
Practice Address - Country:US
Practice Address - Phone:231-714-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion