Provider Demographics
NPI:1518046085
Name:PULVER, LAURIE SELF
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:SELF
Last Name:PULVER
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 1:64 PEACHTREE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3153
Mailing Address - Country:US
Mailing Address - Phone:828-277-3000
Mailing Address - Fax:828-277-3636
Practice Address - Street 1:64 PEACHTREE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3153
Practice Address - Country:US
Practice Address - Phone:828-277-3000
Practice Address - Fax:828-277-3636
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200901798208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913349Medicaid