Provider Demographics
NPI:1154390086
Name:WOLFGANG, LAURA ANN (ANP/BC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:WOLFGANG
Suffix:
Gender:F
Credentials:ANP/BC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:PAGANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:5821 HAUIKI RD
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-8910
Mailing Address - Country:US
Mailing Address - Phone:619-392-0058
Mailing Address - Fax:
Practice Address - Street 1:2-2527 KAUMUALII HWY
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-8309
Practice Address - Country:US
Practice Address - Phone:808-332-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486376363LA2200X
HIAPRN-3149-0363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health