Provider Demographics
NPI:1831491331
Name:MAZE-DAVIS, LAURI (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LAURI
Middle Name:
Last Name:MAZE-DAVIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44429 ORIOLE DR
Mailing Address - Street 2:UNIT 101
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-5947
Mailing Address - Country:US
Mailing Address - Phone:803-431-0734
Mailing Address - Fax:866-591-1741
Practice Address - Street 1:130 BEN CASEY DRIVE
Practice Address - Street 2:STE 102
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6567
Practice Address - Country:US
Practice Address - Phone:803-386-3064
Practice Address - Fax:866-591-1741
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC4345364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health