Healthcare Provider Details

I. General information

NPI: 1942689815
Provider Name (Legal Business Name): LAURA CIOMPI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 WAKE FOREST RD
RALEIGH NC
27609-7317
US

IV. Provider business mailing address

8214 SALTWOOD PL
RALEIGH NC
27617-8729
US

V. Phone/Fax

Practice location:
  • Phone: 919-954-3000
  • Fax:
Mailing address:
  • Phone: 919-906-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-05700
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: