Individual
LAURA ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15 KILLDEER LN, DAYTON, VA 22821-9745
(540) 879-4300
Mailing address
15 KILLDEER LN, DAYTON, VA 22821-9745
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
000000
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0024175237
—
VA
Enumeration date
08/11/2017
Last updated
06/16/2018
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