Healthcare Provider Details

I. General information

NPI: 1629950357
Provider Name (Legal Business Name): LAURA J. BACH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5607 NC HWY 55 SUITE 203
DURHAM NC
27713-4394
US

IV. Provider business mailing address

5607 NC HWY 55 SUITE 203
DURHAM NC
27713-4394
US

V. Phone/Fax

Practice location:
  • Phone: 984-215-0992
  • Fax: 855-271-8304
Mailing address:
  • Phone: 984-215-0992
  • Fax: 855-271-8304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. LAURA JEAN BACH
Title or Position: OWNER/PROVIDER
Credential: PMHNP-BC
Phone: 984-215-0992