Individual
MRS. LAURA MANDEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNTP
Contact information
Practice address
6012 LIBERTY BELL CT, BURKE, VA 22015-3345
(703) 203-5074
Mailing address
6012 LIBERTY BELL CT, BURKE, VA 22015-3345
(703) 203-5074
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
01/06/2023
Last updated
01/06/2023
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