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General NPI Number Information
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NPI Number | 1215108295
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Entity Type | Individual
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Provider Name | LAURA A. DIRICO FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 285 BOULEVARD NE SUITE 345
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City | ATLANTA
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State | GA
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Zip | 30312-4205
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Country | US
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Telephone | 404-653-0039
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Fax | 404-653-0159
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Provider Business Mailing Address
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Address Line | 285 BLVD NE SUITE 345
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City | ATLANTA
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State | GA
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Zip | 30312
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Country | US
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Telephone | 404-653-0039
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Fax | 404-653-0159
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 104267
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License Number State | GA
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