Healthcare Provider Details

I. General information

NPI: 1922354869
Provider Name (Legal Business Name): MARSHA ANN LAIRD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 FARM LIFE AVE
VANCEBORO NC
28586
US

IV. Provider business mailing address

PO BOX 68
POLLOCKSVILLE NC
28573-0068
US

V. Phone/Fax

Practice location:
  • Phone: 252-244-1785
  • Fax: 252-244-2876
Mailing address:
  • Phone: 252-635-3906
  • Fax: 252-224-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5005718
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: