Provider Demographics
NPI:1740429356
Name:WARD, LAURIE DANIELLE (PA)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:DANIELLE
Last Name:WARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SOUTHLAKE PARK STE 200
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-5700
Mailing Address - Country:US
Mailing Address - Phone:205-536-8736
Mailing Address - Fax:205-536-8737
Practice Address - Street 1:1000 SOUTHLAKE PARK STE 200
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-5700
Practice Address - Country:US
Practice Address - Phone:205-536-8736
Practice Address - Fax:205-536-8737
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA634363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALTA1678OtherPA