Healthcare Provider Details

I. General information

NPI: 1114168440
Provider Name (Legal Business Name): LAURA CRUM CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 07/20/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20306 BADGE LANE
ONLEY VA
23418
US

IV. Provider business mailing address

20280 MARKET ST
ONANCOCK VA
23417-1331
US

V. Phone/Fax

Practice location:
  • Phone: 757-787-7374
  • Fax: 757-787-4513
Mailing address:
  • Phone: 574-140-4007
  • Fax: 574-140-5697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR083401
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: