Healthcare Provider Details

I. General information

NPI: 1700918687
Provider Name (Legal Business Name): LAURA ANNE BURNHAM CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 MAPLE LAWN BLVD STE 1, LOWER LOBBY
FULTON MD
20759-2565
US

IV. Provider business mailing address

8110 MAPLE LAWN BLVD STE 235
FULTON MD
20759-2694
US

V. Phone/Fax

Practice location:
  • Phone: 410-531-7557
  • Fax: 410-531-0818
Mailing address:
  • Phone: 301-340-8339
  • Fax: 301-340-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR144985
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: