Healthcare Provider Details

I. General information

NPI: 1396393955
Provider Name (Legal Business Name): LAURA BOTHE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18109 PRINCE PHILIP DR
OLNEY MD
20832-1519
US

IV. Provider business mailing address

18109 PRINCE PHILIP DR
OLNEY MD
20832-1519
US

V. Phone/Fax

Practice location:
  • Phone: 410-207-9541
  • Fax:
Mailing address:
  • Phone: 410-207-9541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR191895
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: