Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 117250 | NC |
NPI | 1063785186 |
---|---|
Provider Name | Laura Stutts Marks |
First Address | Boston, MA 02284-3200 |
Second Address | Rockingham, NC 28379-5220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2012 |
Last Update Date | 31/03/2016 |