Provider Demographics
NPI:1740861624
Name:MASIMORE, LAURA ALEXANDRIA (APRN, CNM, WHNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ALEXANDRIA
Last Name:MASIMORE
Suffix:
Gender:F
Credentials:APRN, CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 SPADE RD
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8805
Mailing Address - Country:US
Mailing Address - Phone:419-341-7256
Mailing Address - Fax:
Practice Address - Street 1:335 GLESSNER AVE FL 2
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2269
Practice Address - Country:US
Practice Address - Phone:567-241-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028610363LW0102X
OHAPRN.CNM.0019471367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health