Provider Demographics
NPI:1972751188
Name:GOURVILLE, LAUREL SKINDER (PNP)
Entity type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:SKINDER
Last Name:GOURVILLE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:32 FATIMA RD
Mailing Address - Street 2:
Mailing Address - City:GILMANTON IRON WORKS
Mailing Address - State:NH
Mailing Address - Zip Code:03837-5649
Mailing Address - Country:US
Mailing Address - Phone:603-931-5500
Mailing Address - Fax:603-364-5038
Practice Address - Street 1:32 FATIMA RD
Practice Address - Street 2:
Practice Address - City:GILMANTON IRON WORKS
Practice Address - State:NH
Practice Address - Zip Code:03837-5649
Practice Address - Country:US
Practice Address - Phone:603-931-5500
Practice Address - Fax:603-364-5038
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168520363LP0200X
NH033688-23363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics