Provider Demographics
NPI:1780955187
Name:BATEMAN, LAURA MARIE (PA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:1ST AND A ST
Mailing Address - City:HAWTHORNE
Mailing Address - State:NV
Mailing Address - Zip Code:89415-1510
Mailing Address - Country:US
Mailing Address - Phone:775-945-2461
Mailing Address - Fax:775-945-2359
Practice Address - Street 1:1ST AND A ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NV
Practice Address - Zip Code:89415-1510
Practice Address - Country:US
Practice Address - Phone:775-945-2461
Practice Address - Fax:775-945-2359
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1322363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant