Individual
MS. HEATHER JOY LAISURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5701 W FRIENDLY AVE, GREENSBORO, NC 27410-4112
(336) 852-1915
(336) 294-3544
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 716-0238
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-03663
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8102686
—
NC
Enumeration date
08/02/2012
Last updated
02/28/2023
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