Provider Demographics
NPI:1740884550
Name:CANADA, LAURA LEE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:CANADA
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 1:14706 KELSEY VISTA DR STE 1B
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6825
Mailing Address - Country:US
Mailing Address - Phone:281-713-9641
Mailing Address - Fax:
Practice Address - Street 1:14502 SPRING CYPRESS RD STE 500
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-7578
Practice Address - Country:US
Practice Address - Phone:281-650-1218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX607038163W00000X
TX1033240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse