Healthcare Provider Details

I. General information

NPI: 1811009202
Provider Name (Legal Business Name): CHIQUITHA A LAIRD RN, NP-BC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST STE 300 THE OB/GYN GROUP OF AUSTIN
AUSTIN TX
78705-1013
US

IV. Provider business mailing address

1301 W 38TH ST STE 300 THE OB/GYN GROUP OF AUSTIN
AUSTIN TX
78705-1013
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-5721
  • Fax: 512-454-2801
Mailing address:
  • Phone: 512-454-5721
  • Fax: 512-454-2081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number612429
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP108766
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: