Individual
MARK LAUREL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3500 GASTON AVE, DALLAS, TX 75246-2017
(214) 820-0111
Mailing address
411 BROADWAY AVE APT 4421, DALLAS, TX 75212-5286
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
STUDENT
TX
Other
Enumeration date
01/27/2020
Last updated
01/27/2020
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