Provider Demographics
NPI:1710799705
Name:MARTIN, LAURIE GENDRON (APRN)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:GENDRON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CRYSTAL LAKE LN
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1856
Mailing Address - Country:US
Mailing Address - Phone:214-793-8835
Mailing Address - Fax:
Practice Address - Street 1:4835 LBJ FWY STE 900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-6001
Practice Address - Country:US
Practice Address - Phone:469-420-5508
Practice Address - Fax:469-619-9690
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1189134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily