Healthcare Provider Details

I. General information

NPI: 1285790949
Provider Name (Legal Business Name): LAUREL S FIELDS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18TH MEDCOM ATTN DCCS QM CREDENTIALS
APO AP
96205-0054
KR

IV. Provider business mailing address

18TH MEDCOM ATTN DCCS QM CREDENTIALS
APO AP
96205 0054
KR

V. Phone/Fax

Practice location:
  • Phone: 01182279176105
  • Fax: 01182279178110
Mailing address:
  • Phone: 01182279166087
  • Fax: 01182279178110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number3274
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: