Provider Demographics
NPI:1912241902
Name:PONCE, LAURA ELIZABETH (LAC, MSOM, DIPLOM)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:PONCE
Suffix:
Gender:F
Credentials:LAC, MSOM, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 LACKMAN RD.
Mailing Address - Street 2:APT. 1407
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217
Mailing Address - Country:US
Mailing Address - Phone:970-759-6901
Mailing Address - Fax:
Practice Address - Street 1:7410 SWITZER RD.
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66214
Practice Address - Country:US
Practice Address - Phone:913-962-7408
Practice Address - Fax:913-962-7416
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist