Healthcare Provider Details

I. General information

NPI: 1083385967
Provider Name (Legal Business Name): LAURA BROTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 JOSEPH SIEWICK DR STE 307
FAIRFAX VA
22033-1760
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 571-419-5645
  • Fax: 571-665-6428
Mailing address:
  • Phone: 571-472-6253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024182720
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024182720
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: