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General NPI Number Information
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NPI Number | 1457455776
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Entity Type | Individual
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Provider Name | LAURENCE LEE TRAIL NP
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Gender | Male
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1126 HORNELL DR
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City | SILVER SPRING
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State | MD
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Zip | 20905-3770
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Country | US
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Telephone | 301-421-9115
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Fax | 202-745-2283
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Provider Business Mailing Address
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Address Line | 1126 HORNELL DRIVE
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City | SILVER SPRING
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State | MD
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Zip | 20905-3770
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Country | US
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Telephone | 301-421-9115
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Fax | 202-745-2283
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R083369
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License Number State | MD
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