Provider Demographics
NPI:1902676786
Name:DUFOUR, LAURA (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DUFOUR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16550 VENTURA BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2014
Mailing Address - Country:US
Mailing Address - Phone:818-208-9204
Mailing Address - Fax:
Practice Address - Street 1:16550 VENTURA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2014
Practice Address - Country:US
Practice Address - Phone:818-208-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95026200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily