Provider Demographics
NPI:1700011699
Name:SMITH, LAURA EASTERWOOD (NP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:EASTERWOOD
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N ELAM AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1127
Mailing Address - Country:US
Mailing Address - Phone:336-547-1552
Mailing Address - Fax:336-547-1711
Practice Address - Street 1:410 S SWING RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-2012
Practice Address - Country:US
Practice Address - Phone:336-632-6566
Practice Address - Fax:336-632-7061
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC204788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily