1134460926 NPI number — DR. LAURA SPRAGUE ANDERSON PSYD

Table of content: DR. LAURA SPRAGUE ANDERSON PSYD (NPI 1134460926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134460926 NPI number — DR. LAURA SPRAGUE ANDERSON PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
LAURA
Provider Middle Name:
SPRAGUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON-KLONTZ
Provider Other First Name:
LAURA
Provider Other Middle Name:
SPRAGUE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134460926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1237
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILAUEA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96754-1237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-639-1404
Provider Business Mailing Address Fax Number:
808-822-4412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4-1435 KUHIO HWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
KAPAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96746-1745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-639-1404
Provider Business Practice Location Address Fax Number:
808-822-4412
Provider Enumeration Date:
03/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 680 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X , with the licence number: PSY 680 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com