Individual
MRS. JACQUELINE LARAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP-BC
Contact information
Practice address
245 MEDICAL PARK DR, FIRST FLOOR, MARION, VA 24354-1100
(276) 378-1341
(276) 378-1205
Mailing address
245 MEDICAL PARK DR, FIRST FLOOR, MARION, VA 24354-1100
(276) 378-1341
(276) 378-1205
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
0024167734
VA
363LA2100X
Acute Care Nurse Practitioner
13443
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093749343
—
VA
05
—
1507124
—
TN
01
—
DF7910
RR MEDICARE
VA
01
—
P00681428
RR MEDICARE
VA
Enumeration date
07/11/2006
Last updated
02/15/2017
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