Healthcare Provider Details

I. General information

NPI: 1811365117
Provider Name (Legal Business Name): LAURA BELAIR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 BRANDON AVE STE 308
SPRINGFIELD VA
22150-2504
US

IV. Provider business mailing address

6120 BRANDON AVE STE 308
SPRINGFIELD VA
22150-2504
US

V. Phone/Fax

Practice location:
  • Phone: 703-646-8538
  • Fax:
Mailing address:
  • Phone: 703-646-8538
  • Fax: 703-451-7219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024173979
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: