Provider Demographics
NPI:1710254453
Name:ANDERSON, LAUREAL JANEICE (DNP)
Entity Type:Individual
Prefix:
First Name:LAUREAL
Middle Name:JANEICE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:LAUREAL
Other - Middle Name:JANEICE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:733 PAVILION VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-9116
Mailing Address - Country:US
Mailing Address - Phone:704-845-5900
Mailing Address - Fax:
Practice Address - Street 1:733 PAVILION VIEW DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-9116
Practice Address - Country:US
Practice Address - Phone:704-845-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23196363LW0102X
NC5017751363LA2200X
TNRN0000178689363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health