Individual
LAURA LEE FELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 S CREASY LN, LAFAYETTE, IN 47905-4972
(765) 502-4960
(765) 502-4016
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71004471A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71004471A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000835730
ANTHEM PROVIDER NUMBER
IN
05
—
201199820
—
IN
Enumeration date
07/07/2013
Last updated
10/15/2024
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