Basic Information
| Provider Information | |||||||||
| NPI: | 1518983865 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NEAL | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | C.N.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PARK WEST BLVD. | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308699777 | ||||||||
| FaxNumber: | 3008656011 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PARK WEST BLVD. | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308699777 | ||||||||
| FaxNumber: | 3008656011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 03/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | RN259831NM07461 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 000000509180 | 01 | OH | ANTHEM | OTHER | 2511277 | 05 | OH | MEDICAID | 7803663 | 01 | OH | AETNA | OTHER |