Provider Demographics
NPI:1376345793
Name:VEGA, LAURA OLIVIA (PMHNP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:OLIVIA
Last Name:VEGA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14344 ANGEL D GARCIA CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-3206
Mailing Address - Country:US
Mailing Address - Phone:915-244-9493
Mailing Address - Fax:
Practice Address - Street 1:532 N TELSHOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8234
Practice Address - Country:US
Practice Address - Phone:575-224-6070
Practice Address - Fax:575-224-6910
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPENDING363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health