Provider Demographics
NPI:1194545111
Name:LAURON, ANTOINELLE
Entity type:Individual
Prefix:
First Name:ANTOINELLE
Middle Name:
Last Name:LAURON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 WOODMAN AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1060
Mailing Address - Country:US
Mailing Address - Phone:661-992-9615
Mailing Address - Fax:
Practice Address - Street 1:6611 WOODMAN AVE APT 206
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1060
Practice Address - Country:US
Practice Address - Phone:661-992-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily