Healthcare Provider Details

I. General information

NPI: 1336919794
Provider Name (Legal Business Name): REBECCA RENEE LAUGHLIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GEORGE MASON DR
ARLINGTON VA
22205-3610
US

IV. Provider business mailing address

7213 STATECREST DR
ANNANDALE VA
22003-1644
US

V. Phone/Fax

Practice location:
  • Phone: 703-907-8923
  • Fax:
Mailing address:
  • Phone: 513-410-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number0001305700
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: