Healthcare Provider Details

I. General information

NPI: 1831291657
Provider Name (Legal Business Name): LAURA HEAD LAMBERT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 TILGHMAN DR
DUNN NC
28334-5510
US

IV. Provider business mailing address

6432 HEAD RD
WILMINGTON NC
28409-2220
US

V. Phone/Fax

Practice location:
  • Phone: 910-892-1000
  • Fax: 910-891-6032
Mailing address:
  • Phone: 910-262-0792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number070430
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: