Provider Demographics
NPI:1124496252
Name:MABEN, LAURA (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MABEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:MABENTENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:333 COMMERCE ST
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37201-1826
Mailing Address - Country:US
Mailing Address - Phone:615-454-9850
Mailing Address - Fax:888-972-4927
Practice Address - Street 1:333 COMMERCE ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37201-1826
Practice Address - Country:US
Practice Address - Phone:615-454-9850
Practice Address - Fax:888-972-4927
Is Sole Proprietor?:No
Enumeration Date:2015-09-06
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily