Provider Demographics
NPI:1437540325
Name:BOLEWARE, LAURA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:BOLEWARE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S. 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4342
Mailing Address - Country:US
Mailing Address - Phone:601-649-7600
Mailing Address - Fax:601-649-7628
Practice Address - Street 1:307 S. 13TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4342
Practice Address - Country:US
Practice Address - Phone:601-649-7600
Practice Address - Fax:601-649-7628
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily