Healthcare Provider Details

I. General information

NPI: 1487324307
Provider Name (Legal Business Name): LAURA BIAZON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COMMERCE PARK DR
RAPHINE VA
24472-2547
US

IV. Provider business mailing address

105 AMHERST CMN
CHARLOTTESVILLE VA
22903-5170
US

V. Phone/Fax

Practice location:
  • Phone: 540-490-2527
  • Fax:
Mailing address:
  • Phone: 443-254-8893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024182549
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: