Basic Information
| Provider Information | |||||||||
| NPI: | 1457418246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHULTZ | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2603 GUILFORD AVE | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284031245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103417213 | ||||||||
| FaxNumber: | 9102518824 | ||||||||
| Practice Location | |||||||||
| Address1: | 304 JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | WHITEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284723602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106406615 | ||||||||
| FaxNumber: | 9106401088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 10/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 187738 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 1457418246 | 05 | NC | MEDICAID |