Individual
LAURA B WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-6000
(864) 560-4023
Mailing address
PO BOX 277723, ATLANTA, GA 30384-7723
(864) 560-4123
(864) 560-4023
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
21035
SC
363LA2100X
Acute Care Nurse Practitioner
21035
SC
363LG0600X
Gerontology Nurse Practitioner
Primary
21035
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP7068
—
SC
01
—
SCB2373365
MEDICARE PIN
SC
01
—
SCB2375019
MEDICARE PIN
SC
01
—
SCB2376084
MEDICARE PIN
SC
01
—
SCB237O696
MEDICARE PIN
SC
Enumeration date
06/02/2017
Last updated
11/07/2024
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