Provider Demographics
NPI:1245292481
Name:STODDARD, LAURA A (MSN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:STODDARD
Suffix:
Gender:F
Credentials:MSN, FNP-BC
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Mailing Address - Street 1:6854 PARKER ROAD
Mailing Address - Street 2:ST. LOUIS CBOC
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130
Mailing Address - Country:US
Mailing Address - Phone:800-228-5459
Mailing Address - Fax:314-868-2561
Practice Address - Street 1:6854 PARKER ROAD
Practice Address - Street 2:ST. LOUIS VA, MO VETERAN CBOC CLINIC
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130
Practice Address - Country:US
Practice Address - Phone:314-286-6988
Practice Address - Fax:314-868-2561
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209-005114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily