Healthcare Provider Details

I. General information

NPI: 1841521341
Provider Name (Legal Business Name): LAURA MCDONALD LAND CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA LYNN MCDONALD CRNA

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10628 PARK RD ANESTHESIA SERVICES
CHARLOTTE NC
28210-8407
US

IV. Provider business mailing address

541 WYNDHAM LN
MARVIN NC
28173-6632
US

V. Phone/Fax

Practice location:
  • Phone: 704-667-1000
  • Fax:
Mailing address:
  • Phone: 704-877-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberXXXXXXXXX
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: