Healthcare Provider Details

I. General information

NPI: 1033699871
Provider Name (Legal Business Name): PAMELA A LAIGLE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18936 FLAT IRON RD
VALLEY LEE MD
20692-3020
US

IV. Provider business mailing address

PO BOX 5
VALLEY LEE MD
20692-0005
US

V. Phone/Fax

Practice location:
  • Phone: 240-925-7997
  • Fax:
Mailing address:
  • Phone: 240-925-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR110954
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: