MEDICARE: LAURA AMISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1649640715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA AMISON

Provider Business Mailing Address
First Line	:	1105 WALL AVE
Second Line	:
City	:	HOPEWELL
State	:	VA
Zip	:	23860-6040
Country	:	US
Telephone Number	:	804-451-8496
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 WALL AVE
Second Line	:
City	:	HOPEWELL
State	:	VA
Zip	:	23860-6040
Country	:	US
Telephone Number	:	804-451-8496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	10/01/2015

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Directions to “ LAURA AMISON ” Practice Location

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