Provider Demographics
NPI:1902876592
Name:VANDERMARTIN, LAURA D (RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:VANDERMARTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122A ILIAMNA AVE
Mailing Address - Street 2:
Mailing Address - City:FT RICHARDSON
Mailing Address - State:AK
Mailing Address - Zip Code:99505-1011
Mailing Address - Country:US
Mailing Address - Phone:907-384-1408
Mailing Address - Fax:
Practice Address - Street 1:TROOP MEDICAL CLINIC
Practice Address - Street 2:724 POSTAL SERVICE LOOP #7499
Practice Address - City:FT RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505
Practice Address - Country:US
Practice Address - Phone:907-384-0600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX700025163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management