MEDICARE: MRS. LAURIE ELLEN GARRELTS NNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SN0000X	Neonatal Clinical Nurse Specialist	221952	NC

General Provider Information

NPI Number	:	1336411248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE ELLEN GARRELTS NNP

Provider Business Mailing Address
First Line	:	2424 ERWIN RD STE 504
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-3826
Country	:	US
Telephone Number	:	919-970-0959
Fax Number	:	919-681-6065

Provider Business Practice Location Address
First Line	:	5524 HOSPITAL N
Second Line	:	BOX 100500 MEDICAL CENTER
City	:	DURHAM
State	:	NC
Zip	:	27710-0001
Country	:	US
Telephone Number	:	919-970-0959
Fax Number	:	919-681-6065

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	04/08/2026

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