=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841156155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA TOMLINES PUTNAM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2025
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21503 WHITES NECK RD
-----------------------------------------------------
City | BUSHWOOD
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20618-2334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-447-3662
-----------------------------------------------------
Fax | 703-447-3662
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21503 WHITES NECK RD
-----------------------------------------------------
City | BUSHWOOD
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20618-2334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-447-3662
-----------------------------------------------------
Fax | 703-447-3662
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 0001322748
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------