Healthcare Provider Details

I. General information

NPI: 1295149151
Provider Name (Legal Business Name): LAURA ALFSTAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA HOSTE

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 MERIDIAN PKWY STE 323
DURHAM NC
27713-4232
US

IV. Provider business mailing address

604 SILVER CHASE DR
KELLER TX
76248-1102
US

V. Phone/Fax

Practice location:
  • Phone: 984-227-8902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP0193
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRE2556
License Number StateGU
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP125822
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: