Provider Demographics
NPI: | 1831812502 |
---|---|
Name: | MINOR, LAURA LEE (CRNP, FNP-BC, LMT) |
Entity type: | Individual |
Prefix: | |
First Name: | LAURA |
Middle Name: | LEE |
Last Name: | MINOR |
Suffix: | |
Gender: | F |
Credentials: | CRNP, FNP-BC, LMT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 7828 HANOVER PKWY APT T1 |
Mailing Address - Street 2: | |
Mailing Address - City: | GREENBELT |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20770-2606 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 202-486-2881 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7828 HANOVER PKWY APT T1 |
Practice Address - Street 2: | |
Practice Address - City: | GREENBELT |
Practice Address - State: | MD |
Practice Address - Zip Code: | 20770-2606 |
Practice Address - Country: | US |
Practice Address - Phone: | 202-486-2881 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2022-09-19 |
Last Update Date: | 2025-07-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | R239546 | 163W00000X, 363LF0000X |
MD | M06155 | 225700000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 163W00000X | Nursing Service Providers | Registered Nurse | |
No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |