Provider Demographics
NPI:1679945125
Name:SWANN, LAURA (CPNP-PC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SWANN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SARAHS LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-4035
Mailing Address - Country:US
Mailing Address - Phone:512-585-8519
Mailing Address - Fax:
Practice Address - Street 1:15930 S GREAT OAKS DR BLDG B
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5791
Practice Address - Country:US
Practice Address - Phone:512-255-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129387363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics