Provider Demographics
NPI:1952552903
Name:BEARD, LAURA JEANNE (NP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEANNE
Last Name:BEARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-6290
Mailing Address - Country:US
Mailing Address - Phone:609-744-6416
Mailing Address - Fax:
Practice Address - Street 1:78 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3304
Practice Address - Country:US
Practice Address - Phone:856-488-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00165900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0179299Medicaid
NJ135685Medicare PIN