Provider Demographics
NPI:1740269844
Name:MAHONY, LAURA (CNM)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MAHONY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301-6 GREAT TEAYS BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-757-3252
Practice Address - Street 1:301-6 GREAT TEAYS BLVD
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560
Practice Address - Country:US
Practice Address - Phone:304-757-6999
Practice Address - Fax:304-757-3252
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV33777163W00000X
WV034367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0160021000Medicaid
WV001721061OtherMS BCBS
WV7972174OtherAETNA
WV2031457Medicare PIN
WV2031456Medicare PIN
WVNM02172Medicare PIN
WVNM02173Medicare PIN
WV2031451Medicare PIN
WVNM02171Medicare PIN
P31342Medicare UPIN
WV2031453Medicare PIN
WV2031455Medicare PIN
WVNM02174Medicare PIN
WV0160021000Medicaid
WV2031452Medicare PIN