Basic Information
Provider Information
NPI: 1801430905
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DINSBEER
FirstName: LAUREN
MiddleName: GRACE
NamePrefix:  
NameSuffix:  
Credential: FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 60447
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282600447
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 7607 NC HIGHWAY 68 N STE B
Address2:  
City: OAK RIDGE
State: NC
PostalCode: 273108803
CountryCode: US
TelephoneNumber: 3366433378
FaxNumber: 3366433670
Other Information
ProviderEnumerationDate: 10/31/2019
LastUpdateDate: 09/08/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/08/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X5012471NCY193400000X MULTIPLE SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


Home