MEDICARE: MS. LAURA J MCGATH RN, CPNP

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	363LP0200X	Pediatric Nurse Practitioner	209004858	IL
2	363LP0200X	Pediatric Nurse Practitioner	0024177831	VA

General Provider Information

NPI Number	:	1770583791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA J MCGATH RN, CPNP

Provider Business Mailing Address
First Line	:	PO BOX 7068
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-0068
Country	:	US
Telephone Number	:	757-483-7113
Fax Number	:	757-483-7151

Provider Business Practice Location Address
First Line	:	4868 BRIDGE RD STE 310
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-2048
Country	:	US
Telephone Number	:	757-483-7113
Fax Number	:	757-483-7151

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

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	09/16/2019

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