Provider Demographics
NPI:1710910385
Name:RENIKER, LAURA N (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:N
Last Name:RENIKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9500
Mailing Address - Country:US
Mailing Address - Phone:704-660-4390
Mailing Address - Fax:704-660-4399
Practice Address - Street 1:171 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9500
Practice Address - Country:US
Practice Address - Phone:704-660-4390
Practice Address - Fax:704-660-4399
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003008032080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135MYOtherNCBCBS
NC89135MYMedicaid
SCN0080EMedicaid
SCN0080EMedicaid
NC89135MYMedicaid
NC2023249AMedicare PIN