Individual
LAURA PONTIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 ALETHA ST, COPPERAS COVE, TX 76522-4101
(254) 368-7111
Mailing address
1301 ALETHA ST, COPPERAS COVE, TX 76522-4101
(254) 368-7111
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
167499
TX
Other
Enumeration date
07/26/2018
Last updated
07/26/2018
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