Basic Information
| Provider Information | |||||||||
| NPI: | 1760818561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEDEBROOK | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | HELEN | ||||||||
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| Credential: | RN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 W MOHAVE RD | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853446349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286699201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 39726 HARQUAHALA MINE RD | ||||||||
| Address2: | |||||||||
| City: | SALOME | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853480000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9288593460 | ||||||||
| FaxNumber: | 9288593475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2013 | ||||||||
| LastUpdateDate: | 06/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | COA.14959-NP | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | AP5608 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.