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General NPI Number Information
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NPI Number | 1457541484
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Entity Type | Organization
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Legal Business Name | NORTH RIVER PRIMECARE PC
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 301 JONES AVE
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City | BEAUFORT
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State | NC
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Zip | 28516-1514
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Country | US
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Telephone | 252-728-3252
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Fax | 252-728-3251
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Provider Business Mailing Address
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Address Line | 301 JONES AVE
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City | BEAUFORT
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State | NC
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Zip | 28516-1514
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Country | US
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Telephone | 252-728-3252
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Fax | 252-728-3251
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Authorized Official
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Title or Position | OWNER
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Name | LAURA H. GAULDEN
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Credential | ANP
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Telephone | 252-728-3252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 200400309
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 900119
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License Number State | NC
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