=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629950357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURA J. BACH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2025
-----------------------------------------------------
Last Update Date | 07/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5607 NC HWY 55 SUITE 203
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27713-4394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 984-215-0992
-----------------------------------------------------
Fax | 855-271-8304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5607 NC HWY 55 SUITE 203
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27713-4394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 984-215-0992
-----------------------------------------------------
Fax | 855-271-8304
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | MS. LAURA JEAN BACH
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 984-215-0992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------