Provider Demographics
NPI:1770340291
Name:PAGE, LAURIE ELIZABETH (APRN)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ELIZABETH
Last Name:PAGE
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PINEVIEW DR STE 205
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3814
Mailing Address - Country:US
Mailing Address - Phone:336-329-3295
Mailing Address - Fax:
Practice Address - Street 1:855 SAM NEWELL RD STE 204
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-7594
Practice Address - Country:US
Practice Address - Phone:980-202-6643
Practice Address - Fax:980-246-9482
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019706363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily