Healthcare Provider Details

I. General information

NPI: 1396165239
Provider Name (Legal Business Name): LINDA LAWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 HEALTH SERVICES RD
SPARTA NC
28675-3000
US

IV. Provider business mailing address

104 E STUART DR
GALAX VA
24333-2119
US

V. Phone/Fax

Practice location:
  • Phone: 336-372-5641
  • Fax: 336-372-7793
Mailing address:
  • Phone: 276-238-9902
  • Fax: 276-238-9907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5006820
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: