Healthcare Provider Details

I. General information

NPI: 1437717238
Provider Name (Legal Business Name): HEATHER ALICO LAURIA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5107 SOUTHPARK DR STE 203
DURHAM NC
27713-8400
US

IV. Provider business mailing address

5107 SOUTHPARK DR STE 203
DURHAM NC
27713-8400
US

V. Phone/Fax

Practice location:
  • Phone: 984-265-7337
  • Fax: 984-224-8726
Mailing address:
  • Phone: 984-265-7337
  • Fax: 984-224-8726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011882
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2018091253
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: