Provider Demographics
NPI:1174564249
Name:MAYER, LAURA RENEE (C ANP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:RENEE
Last Name:MAYER
Suffix:
Gender:
Credentials:C ANP
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:RENNE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3075 US ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-8859
Mailing Address - Country:US
Mailing Address - Phone:304-528-4600
Mailing Address - Fax:
Practice Address - Street 1:3075 US ROUTE 60 STE D265
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-8859
Practice Address - Country:US
Practice Address - Phone:304-528-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV65080363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2514612Medicaid
WVP0015Z600OtherRAILROAD MEDICARE
WV3810000610Medicaid
Q24311Medicare UPIN
OH2514612Medicaid