Provider Demographics
NPI:1629667514
Name:LAURIE, ANSLEY DANIELLE
Entity Type:Individual
Prefix:
First Name:ANSLEY
Middle Name:DANIELLE
Last Name:LAURIE
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 1:3330 JEDDO RD
Mailing Address - Street 2:
Mailing Address - City:URIAH
Mailing Address - State:AL
Mailing Address - Zip Code:36480-4302
Mailing Address - Country:US
Mailing Address - Phone:251-593-8817
Mailing Address - Fax:
Practice Address - Street 1:3330 JEDDO RD
Practice Address - Street 2:
Practice Address - City:URIAH
Practice Address - State:AL
Practice Address - Zip Code:36480-4302
Practice Address - Country:US
Practice Address - Phone:251-593-8817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program