Provider Demographics
NPI:1932551124
Name:DE LEON - ESCOBEDO, LAURIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:DE LEON - ESCOBEDO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15904 E. FM 1762
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580
Mailing Address - Country:US
Mailing Address - Phone:956-245-3330
Mailing Address - Fax:
Practice Address - Street 1:608 N ED CAREY DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7912
Practice Address - Country:US
Practice Address - Phone:956-364-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily