Provider Demographics
NPI:1316137128
Name:HEDIGER, LAURA A (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:HEDIGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 505164
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5164
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:
Practice Address - Street 1:2230 S GLENSTONE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3255
Practice Address - Country:US
Practice Address - Phone:417-820-7278
Practice Address - Fax:417-820-4068
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO080311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
500410007OtherMARIAN CENTER PROVIDER
ARPENDINGOtherAR BLUE SHIELD
MOPENDINGMedicaid
MOPENDINGMedicaid
ARPENDINGOtherAR BLUE SHIELD