Healthcare Provider Details

I. General information

NPI: 1871565440
Provider Name (Legal Business Name): KAREN LAUREL - FORBES BLEIER CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 FIRST COLONIAL RD
VIRGINIA BEACH VA
23454-3002
US

IV. Provider business mailing address

3100 MONET DR
VIRGINIA BEACH VA
23453-5510
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-8191
  • Fax:
Mailing address:
  • Phone: 757-478-4944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number2371
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: