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NPI Code Detail

MEDICARE: MRS. LAURA MARIE LISTON FNP

MEDICARE: MRS. LAURA MARIE LISTON FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner5007945NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1007174857OTHERNCUHC
22013POTHERNCBCBS

General Provider Information

NPI Number : 1225432735
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA MARIE LISTON FNP
Provider Business Mailing Address
First Line : 801 E MOREHEAD ST STE 100
Second Line :
City : CHARLOTTE
State : NC
Zip : 28202-3195
Country : US
Telephone Number : 704-342-0252
Fax Number : 980-533-7801
Provider Business Practice Location Address
First Line : 801 E MOREHEAD ST STE 100
Second Line :
City : CHARLOTTE
State : NC
Zip : 28202-3195
Country : US
Telephone Number : 704-342-0252
Fax Number : 980-533-7801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2014
Last Update Date : 06/12/2026

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