Individual
MS. LAURA CHRISTINE WANNALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE
Contact information
Practice address
1012 EASTBOURNE DR, LA PLATA, MD 20646-3562
(240) 416-3508
Mailing address
1012 EASTBOURNE DR, LAPLATA, MD 20646
(240) 416-3508
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R107921
MD
Other
Enumeration date
08/15/2011
Last updated
08/15/2011
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