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General NPI Number Information
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NPI Number | 1659842391
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Entity Type | Individual
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Provider Name | LAURA ROMAN CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 13135 LEE JACKSON MEMORIAL HWY
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City | FAIRFAX
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State | VA
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Zip | 22033-1907
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Country | US
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Telephone | 703-391-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 2320 MEADOW WILLOW CIR
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City | HERNDON
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State | VA
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Zip | 20171-4864
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Country | US
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Telephone | 540-998-8225
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0024177024
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License Number State | VA
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