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 FL 1, 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
363LA2100X
Acute Care Nurse Practitioner
3-002978
AL
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
06/28/2026
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