Provider Demographics
NPI:1912613522
Name:GRIGORYAN, LAURA NICOLETTE (NP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:NICOLETTE
Last Name:GRIGORYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 W BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1237
Mailing Address - Country:US
Mailing Address - Phone:818-238-9850
Mailing Address - Fax:
Practice Address - Street 1:2407 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1237
Practice Address - Country:US
Practice Address - Phone:818-238-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023683363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner