Healthcare Provider Details

I. General information

NPI: 1417890856
Provider Name (Legal Business Name): VILBRUNE PHARA LAURISTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 WATSON BLVD STE 2
WARNER ROBINS GA
31093-9601
US

IV. Provider business mailing address

2929 WATSON BLVD. STE 2 PMB 108
WARNER ROBINS GA
31093
US

V. Phone/Fax

Practice location:
  • Phone: 720-924-6482
  • Fax:
Mailing address:
  • Phone: 720-924-6482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP340424
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN-NP340424
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: