Provider Demographics
NPI:1306887963
Name:LAURIN, NIDA K (MD)
Entity type:Individual
Prefix:DR
First Name:NIDA
Middle Name:K
Last Name:LAURIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NIDA
Other - Middle Name:K
Other - Last Name:LAURIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9817 N 95TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4587
Mailing Address - Country:US
Mailing Address - Phone:480-779-3997
Mailing Address - Fax:480-779-1305
Practice Address - Street 1:9817 N 95TH ST STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4587
Practice Address - Country:US
Practice Address - Phone:480-779-3997
Practice Address - Fax:480-779-1305
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ352842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ955263Medicaid
AZ1638817OtherCIGNA