Provider Demographics
NPI:1396884722
Name:BRISBOE, LAURA M (CNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:BRISBOE
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-4911
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:463 E CIRCLE DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7500
Practice Address - Country:US
Practice Address - Phone:517-884-6546
Practice Address - Fax:517-432-9460
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704177648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1396884722Medicaid
MI0N36090002002Medicare ID - Type Unspecified
MI0M61830023Medicare PIN