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General NPI Number Information
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NPI Number | 1093724015
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Entity Type | Individual
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Provider Name | LAURA TRICE NP
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Gender | Female
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 777 HEMLOCK ST HOSPITAL BOX 64
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City | MACON
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State | GA
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Zip | 31201-2102
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Country | US
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Telephone | 478-633-2097
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Fax | 478-633-7836
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Provider Business Mailing Address
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Address Line | 307 TRICE RD
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City | MILNER
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State | GA
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Zip | 30257-3423
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Country | US
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Telephone | 770-228-5878
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN066916
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License Number State | GA
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