Provider Demographics
NPI:1629099577
Name:HOLLAND, LAURA ELLEN (ANP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ELLEN
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:HOLLAND
Other - Last Name:GAULDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:301 JONES AVENUE
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516
Mailing Address - Country:US
Mailing Address - Phone:252-728-3252
Mailing Address - Fax:252-728-3251
Practice Address - Street 1:301 JONES AVENUE
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516
Practice Address - Country:US
Practice Address - Phone:252-728-3252
Practice Address - Fax:252-728-3251
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900119363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907341Medicaid
NC7004456Medicaid
NC7004406Medicaid
NC7004456Medicaid
NC7004406Medicaid