Provider Demographics
NPI:1720331465
Name:TEKLITS, LAURIE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:TEKLITS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:WITTMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1655 WAKE DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4746
Mailing Address - Country:US
Mailing Address - Phone:919-556-4779
Mailing Address - Fax:919-556-5277
Practice Address - Street 1:1655 WAKE DR UNIT 101
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4746
Practice Address - Country:US
Practice Address - Phone:919-556-4779
Practice Address - Fax:919-556-5277
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC283087363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC283087OtherLICENSE