Provider Demographics
NPI:1417646936
Name:NSDR PA
Entity Type:Organization
Organization Name:NSDR PA
Other - Org Name:NAILSPADR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:PURDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-644-8373
Mailing Address - Street 1:PO BOX 1764
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-1445
Mailing Address - Country:US
Mailing Address - Phone:916-333-9557
Mailing Address - Fax:
Practice Address - Street 1:2242 FORT WORTH AVE STE 115
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1864
Practice Address - Country:US
Practice Address - Phone:972-803-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty