Provider Demographics
NPI:1871515635
Name:ROSE, LAURA M (CPNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:ROSE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10406 ARTEMEL LANE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066
Mailing Address - Country:US
Mailing Address - Phone:703-759-7377
Mailing Address - Fax:
Practice Address - Street 1:6303 LITTLE RIVER TPKE
Practice Address - Street 2:#300
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312
Practice Address - Country:US
Practice Address - Phone:703-914-8989
Practice Address - Fax:703-914-5494
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024162510363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics