Provider Demographics
NPI:1215536917
Name:BARCLAY, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BARCLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 28TH AVE S APT 307
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6671
Mailing Address - Country:US
Mailing Address - Phone:701-741-4522
Mailing Address - Fax:
Practice Address - Street 1:3783 S 16TH ST APT 118
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5332
Practice Address - Country:US
Practice Address - Phone:701-521-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant