MEDICARE: PRIMARY MEDICAL CARE AT THE CROSSROADS, PLLC

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
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1801428487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY MEDICAL CARE AT THE CROSSROADS, PLLC

Provider Business Mailing Address
First Line	:	58 OLD ROBERTS RD STE 102
Second Line	:
City	:	BENSON
State	:	NC
Zip	:	27504-8047
Country	:	US
Telephone Number	:	919-889-6601
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 OLD ROBERTS RD STE 102
Second Line	:
City	:	BENSON
State	:	NC
Zip	:	27504-8047
Country	:	US
Telephone Number	:	919-889-6601
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	LAURA LANIER
Credential	:	FNP
Telephone Number	:	919-889-6601

Provider Enumeration Date	:	02/11/2020
Last Update Date	:	02/11/2020

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