Provider Demographics
NPI:1992343362
Name:MCMAHON, LAURIE ANNE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ANNE
Last Name:MCMAHON
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13105 E COLOSSAL CAVE RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-6775
Mailing Address - Country:US
Mailing Address - Phone:520-686-2079
Mailing Address - Fax:520-337-6340
Practice Address - Street 1:13105 E COLOSSAL CAVE RD UNIT 3
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-6775
Practice Address - Country:US
Practice Address - Phone:520-686-2079
Practice Address - Fax:520-337-6340
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235884207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program