Provider Demographics
NPI:1699717702
Name:MRNUSTIK, LAURA VAUGHAN (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:VAUGHAN
Last Name:MRNUSTIK
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:9003 AIRPORT FWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7770
Mailing Address - Country:US
Mailing Address - Phone:817-514-5200
Mailing Address - Fax:817-514-5210
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:BLDG. 2, SUITE 350
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2875
Practice Address - Country:US
Practice Address - Phone:972-556-1616
Practice Address - Fax:972-556-1740
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX709435363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ71152Medicare UPIN
TX8G7735Medicare ID - Type Unspecified