Healthcare Provider Details

I. General information

NPI: 1508550724
Provider Name (Legal Business Name): LAURA RICE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5659 S PARKWAY DRIVE #100
GLOUCESTER VA
23061
US

IV. Provider business mailing address

14623 WINGAPO DR
LANEXA VA
23089-6140
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 757-943-2344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001235190
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024187749
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: