Healthcare Provider Details

I. General information

NPI: 1750916862
Provider Name (Legal Business Name): LAURA ANN STOBER RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 KEMPSVILLE RD
NORFOLK VA
23502-2205
US

IV. Provider business mailing address

158 N BEAR DEN RD
WAYNESBORO VA
22980-8910
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-5001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number0117002200
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: