Provider Demographics
NPI:1841521341
Name:LAND, LAURA MCDONALD (CRNA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MCDONALD
Last Name:LAND
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:541 WYNDHAM LN
Mailing Address - Street 2:
Mailing Address - City:MARVIN
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6632
Mailing Address - Country:US
Mailing Address - Phone:704-877-7575
Mailing Address - Fax:
Practice Address - Street 1:10628 PARK RD
Practice Address - Street 2:ANESTHESIA SERVICES
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8407
Practice Address - Country:US
Practice Address - Phone:704-667-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCXXXXXXXXX367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8053895Medicaid
SCNAN979Medicaid
NC2618418Medicare PIN