Healthcare Provider Details

I. General information

NPI: 1013549260
Provider Name (Legal Business Name): LAUREN STORY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E MARSHALL ST
RICHMOND VA
23298-5054
US

IV. Provider business mailing address

2603 EDGEWOOD AVE
RICHMOND VA
23222-3513
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-0450
  • Fax:
Mailing address:
  • Phone: 804-869-5498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024178356
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: