Individual
LAURA ELIZABETH PEDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
305 LANGDON ST, SOMERSET, KY 42503-2750
(606) 679-7441
Mailing address
1066 WHITE OAK AVE, MARYVILLE, TN 37803-2884
(865) 924-4995
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04600
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2017
Last updated
05/09/2020
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