Healthcare Provider Details

I. General information

NPI: 1730585241
Provider Name (Legal Business Name): LAURA MADISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 S GRAZING CT
SNEADS FERRY NC
28460-6854
US

IV. Provider business mailing address

403 S GRAZING CT
SNEADS FERRY NC
28460-6854
US

V. Phone/Fax

Practice location:
  • Phone: 508-981-9364
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number242581
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: