Healthcare Provider Details

I. General information

NPI: 1780104497
Provider Name (Legal Business Name): LAURA ANGLIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 EAST BLVD
CHARLOTTE NC
28203-5204
US

IV. Provider business mailing address

900 EAST BLVD
CHARLOTTE NC
28203-5204
US

V. Phone/Fax

Practice location:
  • Phone: 704-655-8988
  • Fax: 980-218-0299
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009584
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: