Provider Demographics
NPI:1386161800
Name:MCFADDEN, LAURA ELIZABETH
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:MCFADDEN
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 1:711 N 36TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2977
Mailing Address - Country:US
Mailing Address - Phone:816-271-7826
Mailing Address - Fax:
Practice Address - Street 1:711 N 36TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2977
Practice Address - Country:US
Practice Address - Phone:816-271-7826
Practice Address - Fax:816-271-1266
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018002984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily