Basic Information
| Provider Information | |||||||||
| NPI: | 1538182191 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEWYER | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | APRN,BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 W BAY AREA BLVD | ||||||||
| Address2: | #500 | ||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815542200 | ||||||||
| FaxNumber: | 2815544340 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 W BAY AREA BLVD | ||||||||
| Address2: | #500 | ||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815542200 | ||||||||
| FaxNumber: | 2815544340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363LF0000X | 649994 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.