Provider Demographics
NPI:1306266028
Name:WHITTAKER, LAURA MINERO (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MINERO
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ELIZABETH
Other - Last Name:MINERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1707 BEECH BEND DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077
Mailing Address - Country:US
Mailing Address - Phone:281-814-0196
Mailing Address - Fax:
Practice Address - Street 1:6621 FANNIN ST. CLINICAL CARE CENTER SUITE 950
Practice Address - Street 2:TEXAS CHILDREN'S HOSPITAL
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-826-1075
Practice Address - Fax:832-825-3504
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical