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NPI Code Detail

MEDICARE: MS. CAROL GERARDA LA FAUCI NP

MEDICARE: MS. CAROL GERARDA LA FAUCI 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
1363LG0600XGerontology Nurse Practitioner0024166098VA

General Provider Information

NPI Number : 1912068875
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CAROL GERARDA LA FAUCI NP
Provider Business Mailing Address
First Line : 1500 E LITTLE CREEK RD
Second Line : SUITE 205
City : NORFOLK
State : VA
Zip : 23518-4137
Country : US
Telephone Number : 757-587-4744
Fax Number : 757-587-4947
Provider Business Practice Location Address
First Line : 1500 E LITTLE CREEK RD
Second Line : SUITE 205
City : NORFOLK
State : VA
Zip : 23518-4137
Country : US
Telephone Number : 757-587-4744
Fax Number : 757-587-4947
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 07/08/2007

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