Provider Demographics
NPI:1699804104
Name:SILLS, LAURA J (RN, MSN, ANP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:SILLS
Suffix:
Gender:F
Credentials:RN, MSN, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 MEYER RD
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3800
Mailing Address - Country:US
Mailing Address - Phone:314-230-1500
Mailing Address - Fax:314-230-1122
Practice Address - Street 1:1060 MEYER RD
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3800
Practice Address - Country:US
Practice Address - Phone:314-230-1500
Practice Address - Fax:314-230-1122
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO130812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO130812OtherADULT NP LICENSE