Healthcare Provider Details

I. General information

NPI: 1619895323
Provider Name (Legal Business Name): DESMOND ANDRE LABOR JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7008 LITTLE RIVER TPKE STE G
ANNANDALE VA
22003-3234
US

IV. Provider business mailing address

14078 KRAMER PL
WOODBRIDGE VA
22193-5929
US

V. Phone/Fax

Practice location:
  • Phone: 833-992-0637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001314668
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: