Healthcare Provider Details

I. General information

NPI: 1174999304
Provider Name (Legal Business Name): LAURA DOUSE SHERNIT WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA CARROLL DOUSE RN

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 11/27/2023
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3299 WOODBURN RD STE 350
ANNANDALE VA
22003-7321
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 703-260-1179
  • Fax: 571-405-6234
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN1019721
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN217592
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024172859
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024172859
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: