Provider Demographics
NPI:1033233606
Name:POWELL, LAURA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4353
Mailing Address - Country:US
Mailing Address - Phone:252-328-6841
Mailing Address - Fax:
Practice Address - Street 1:1000 E 5TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-2502
Practice Address - Country:US
Practice Address - Phone:252-328-6841
Practice Address - Fax:540-368-8095
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009570363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics