Healthcare Provider Details

I. General information

NPI: 1114859931
Provider Name (Legal Business Name): LAURA POLE RN, NP, CNS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 LAKESHORE TERRACE RD
HARDY VA
24101-3516
US

IV. Provider business mailing address

820 LAKESHORE TERRACE RD
HARDY VA
24101-3516
US

V. Phone/Fax

Practice location:
  • Phone: 540-529-5395
  • Fax:
Mailing address:
  • Phone: 540-529-5395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number0001099169
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024181960
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: