Provider Demographics
NPI:1770039059
Name:CLOSE, LAURA MARY (APRN - FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARY
Last Name:CLOSE
Suffix:
Gender:F
Credentials:APRN - FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 CONGRESS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3166
Mailing Address - Country:US
Mailing Address - Phone:207-771-5549
Mailing Address - Fax:
Practice Address - Street 1:887 CONGRESS ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3166
Practice Address - Country:US
Practice Address - Phone:207-771-5549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily