Healthcare Provider Details

I. General information

NPI: 1922679539
Provider Name (Legal Business Name): CRISTINA MARIE LAABS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 RIBAUT RD STE 101
BEAUFORT SC
29902-5477
US

IV. Provider business mailing address

90 BEERS RD
EASTON CT
06612-1722
US

V. Phone/Fax

Practice location:
  • Phone: 843-525-0045
  • Fax:
Mailing address:
  • Phone: 203-516-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5716
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: