Basic Information
| Provider Information | |||||||||
| NPI: | 1740861624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASIMORE | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ALEXANDRIA | ||||||||
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| Credential: | APRN, CNM, WHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2616 SPADE RD | ||||||||
| Address2: | |||||||||
| City: | UNIONTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446858805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193417256 | ||||||||
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| Practice Location | |||||||||
| Address1: | 335 GLESSNER AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449032269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5672417055 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2021 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | APRN.CNP.0028610 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 367A00000X | APRN.CNM.0019471 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.