Provider Demographics
NPI:1477560878
Name:CABRAL, LAURIE (CFNP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:CABRAL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 CENTRAL AVE E
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-9602
Mailing Address - Country:US
Mailing Address - Phone:601-928-6600
Mailing Address - Fax:601-928-6658
Practice Address - Street 1:1222 S MAIN ST
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-3318
Practice Address - Country:US
Practice Address - Phone:601-795-9320
Practice Address - Fax:601-795-9876
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR716413363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
500027732OtherRAILROAD MEDICARE
MS00123695Medicaid
MS640507572RVOtherAMERICAN ADMIN GROUP
E96733Medicare UPIN
500001076Medicare ID - Type Unspecified