Provider Demographics
NPI:1023078425
Name:FOX, LAURA A (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:FOX
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5436
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5436
Mailing Address - Country:US
Mailing Address - Phone:308-384-9300
Mailing Address - Fax:308-384-4542
Practice Address - Street 1:418 N WEBB RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4045
Practice Address - Country:US
Practice Address - Phone:308-384-9300
Practice Address - Fax:308-384-4542
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025016800Medicaid
NE01880OtherBCBS OF NE
NE278228Medicare ID - Type Unspecified
NES50802Medicare UPIN