Provider Demographics
NPI:1962516450
Name:ANDERSON, LAURA L (APRN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:11946 STANDING STONE DR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-8094
Practice Address - Country:US
Practice Address - Phone:402-815-4500
Practice Address - Fax:402-815-4510
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110811363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731741Medicaid
NE47068731749Medicaid
NE47068731734Medicaid
NE10026450100Medicaid
IA10026450100Medicaid
NE47068731734Medicaid