Provider Demographics
NPI:1982681201
Name:MCLAURIN, ELLEN BRIDGES (FNP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:BRIDGES
Last Name:MCLAURIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613A RAEFORD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2113
Mailing Address - Country:US
Mailing Address - Phone:910-483-1493
Mailing Address - Fax:910-920-4212
Practice Address - Street 1:3613A RAEFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2113
Practice Address - Country:US
Practice Address - Phone:919-544-6318
Practice Address - Fax:919-544-6336
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004084Medicaid
NC201472OtherSTATE LICENSE #
NC201472OtherSTATE LICENSE #
NC2809317AMedicare PIN