Provider Demographics
NPI:1154793685
Name:MASTERS, LAURA BETH (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:MASTERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:BETH
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:SHELLEY STAYMATES
Mailing Address - Street 2:890 W ELLIOTT #120
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233
Mailing Address - Country:US
Mailing Address - Phone:480-500-2285
Mailing Address - Fax:919-882-8575
Practice Address - Street 1:SHELLEY STAYMATES
Practice Address - Street 2:890 W ELLIOTT #120
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233
Practice Address - Country:US
Practice Address - Phone:480-500-2285
Practice Address - Fax:919-882-8575
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2023-05-24
Deactivation Date:2018-06-30
Deactivation Code:
Reactivation Date:2018-07-10
Provider Licenses
StateLicense IDTaxonomies
NE111934363LF0000X
AZAP11253363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE111934OtherSTATE LICENSE
AZAP11253OtherSTATE LICENSE