Individual
LAURA L RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
(260) 436-8585
Mailing address
PO BOX 2526, FORT WAYNE, IN 46801-2526
(260) 436-8686
(260) 436-8585
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71006059A
IN
363LF0000X
Family Nurse Practitioner
AP5741
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000990752
ANTHEM
IN
05
—
201343770
—
IN
Enumeration date
07/31/2014
Last updated
11/10/2016
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