MEDICARE: LETITIA AMIRAULT NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024166186	VA

General Provider Information

NPI Number	:	1881662112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETITIA AMIRAULT NP

Provider Business Mailing Address
First Line	:	PO BOX 490
Second Line	:
City	:	MONTEREY
State	:	VA
Zip	:	24465-0490
Country	:	US
Telephone Number	:	540-468-6400
Fax Number	:	540-468-3301

Provider Business Practice Location Address
First Line	:	120 JACKSON RIVER ROAD
Second Line	:
City	:	MONTEREY
State	:	VA
Zip	:	24465
Country	:	US
Telephone Number	:	540-468-3300
Fax Number	:	540-465-3301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2006
Last Update Date	:	03/31/2022

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