Provider Demographics
NPI:1437263720
Name:BACH, LAURA (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:BACH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607 NC HIGHWAY 55 STE 203
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4394
Mailing Address - Country:US
Mailing Address - Phone:984-215-0992
Mailing Address - Fax:855-271-8304
Practice Address - Street 1:5607 NC HIGHWAY 55 STE 203
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4394
Practice Address - Country:US
Practice Address - Phone:984-215-0992
Practice Address - Fax:855-271-8304
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC158521163WP0809X
NC201365363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2805696AMedicare PIN