Provider Demographics
NPI:1982148011
Name:WOOLEY, LAURA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:WOOLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:BEDDOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:640 W MOANA LN STE 1
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4903
Mailing Address - Country:US
Mailing Address - Phone:775-324-0699
Mailing Address - Fax:775-323-6814
Practice Address - Street 1:640 W MOANA LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4903
Practice Address - Country:US
Practice Address - Phone:775-324-0699
Practice Address - Fax:775-323-6814
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2856363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant