Provider Demographics
NPI:1538165709
Name:PRADO, LAURA ELLEN (DNP, NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELLEN
Last Name:PRADO
Suffix:
Gender:F
Credentials:DNP, NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELLEN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, NP
Mailing Address - Street 1:2001 PEACHTREE RD NE STE 575
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1476
Mailing Address - Country:US
Mailing Address - Phone:404-350-0106
Mailing Address - Fax:404-350-0176
Practice Address - Street 1:2001 PEACHTREE RD NE STE 575
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1476
Practice Address - Country:US
Practice Address - Phone:404-350-0106
Practice Address - Fax:404-350-0176
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN122652363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00242555OtherRAILROAD MEDICARE
P00242555OtherRAILROAD MEDICARE
P83841Medicare UPIN