=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023435831
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURIE A EDWARDS NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2014
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2340 SPRING FOREST RD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27615-7528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-872-6355
-----------------------------------------------------
Fax | 401-652-9787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 178 TURNERSBURG HWY MINUTE CLINIC
-----------------------------------------------------
City | STATESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28625-2890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-389-2727
-----------------------------------------------------
Fax | 401-652-9787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5006803
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------