Provider Demographics
NPI:1073934063
Name:REEVEY, LAURA (NP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:REEVEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CLARICE AVE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204
Mailing Address - Country:US
Mailing Address - Phone:704-348-4000
Mailing Address - Fax:704-927-2952
Practice Address - Street 1:1640 CAMPUS PARK DR STE C
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5284
Practice Address - Country:US
Practice Address - Phone:704-226-0366
Practice Address - Fax:704-226-9535
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006578363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner