Provider Demographics
NPI:1922847011
Name:LLB LASER LLC
Entity type:Organization
Organization Name:LLB LASER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DVORK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-243-1526
Mailing Address - Street 1:4905 S 107TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1940
Mailing Address - Country:US
Mailing Address - Phone:402-243-1526
Mailing Address - Fax:
Practice Address - Street 1:4905 S 107TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1940
Practice Address - Country:US
Practice Address - Phone:402-243-1526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIDE HEALTH CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-20
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty