Mabry, Laura Theresa

Mabry, Laura Theresa is an individual health care provider with primary practice located at 621 Memorial Dr Ste 403 , South Bend IN 46601-1074. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, which is considered as her primary health care specialty. Mabry, Laura Theresa can be contacted via phone (574) 647-1405.

Contact Information

Primary practice address
621 Memorial Dr Ste 403 South Bend IN 46601-1074
Phone: (574) 647-1405
Fax: (574) 647-3970
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X 09000186A Indiana

Profile Details

NPI number 1184952848
LBN Legal business name Mabry, Laura Theresa
Credentials MSN, CNM
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 18th, 2009
Last updated Apr 28th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184952848 NPPES
Indiana MEDICAID 200976360

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