Healthcare Provider Details

I. General information

NPI: 1821345117
Provider Name (Legal Business Name): LAURA M MARSH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 EUBANK BLVD NE STE 6
ALBUQUERQUE NM
87112-4160
US

IV. Provider business mailing address

PO BOX 95590
ALBUQUERQUE NM
87199-5590
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-8806
  • Fax: 888-503-8511
Mailing address:
  • Phone: 505-503-8806
  • Fax: 505-217-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02008
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: