Healthcare Provider Details

I. General information

NPI: 1467401646
Provider Name (Legal Business Name): LAURA JEAN HERRING APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA JEAN HERRING MS, ATC, CSCS

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2436 SANDY BROOK LN
MIDLOTHIAN VA
23112-4055
US

IV. Provider business mailing address

2436 SANDY BROOK LN
MIDLOTHIAN VA
23112-4055
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-6136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024179982
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: