1538772132 NPI number — LAURA GRANT SNEAD FNP-C

Table of content: LAURA GRANT SNEAD FNP-C (NPI 1538772132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538772132 NPI number — LAURA GRANT SNEAD FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNEAD
Provider First Name:
LAURA
Provider Middle Name:
GRANT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538772132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
219 GODFREY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLERBE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28338-8372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
472-203-6740
Provider Business Mailing Address Fax Number:
910-384-5202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1206 FULTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAEFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28376-1926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
472-203-6740
Provider Business Practice Location Address Fax Number:
910-384-5202
Provider Enumeration Date:
08/25/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  5013451 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5013451 . This is a "NC BOARD OF NURSING APPROVAL NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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