Provider Demographics
NPI:1144631599
Name:NETZLEY, LAURA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARIE
Last Name:NETZLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1440
Mailing Address - Fax:
Practice Address - Street 1:9224 ARDREY KELL RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4952
Practice Address - Country:US
Practice Address - Phone:704-316-1495
Practice Address - Fax:704-316-1496
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-01001208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics