Provider Demographics
NPI:1073297107
Name:CARVAJAL, LAURA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CARVAJAL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 WASHINGTON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-5709
Mailing Address - Country:US
Mailing Address - Phone:508-796-9211
Mailing Address - Fax:508-286-6106
Practice Address - Street 1:489 WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-5709
Practice Address - Country:US
Practice Address - Phone:508-796-9211
Practice Address - Fax:508-286-6106
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2322506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2322506OtherBOARD OF REGISTRATION IN NURSING