Individual
LAURA M TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2006 HEALTH CAMPUS DR STE 300, ROCKINGHAM, VA 22801-8679
(540) 689-7400
(757) 963-9617
Mailing address
2006 HEALTH CAMPUS DR STE 300, ROCKINGHAM, VA 22801-8679
(540) 689-7400
(757) 963-9617
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
003606
OH
363AM0700X
Medical Physician Assistant
Primary
0110004049
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033461520
—
VA
Enumeration date
10/08/2012
Last updated
08/17/2023
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