Provider Demographics
NPI:1649677931
Name:LEWIS, LAURA ANN (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:BEAULIEU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 MARLOWE CT
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2480
Mailing Address - Country:US
Mailing Address - Phone:919-525-5596
Mailing Address - Fax:
Practice Address - Street 1:DUMC 3118 466 G SEELEY MUDD BUILDING
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-674-6858
Practice Address - Fax:919-684-6044
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007362363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care