1255696381 NPI number — MISS LAURA FAILLA FNP-C

Table of content: MISS LAURA FAILLA FNP-C (NPI 1255696381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255696381 NPI number — MISS LAURA FAILLA FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAILLA
Provider First Name:
LAURA
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255696381
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 MEMORIAL DRIVE RM 134
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20892-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-669-5323
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 CENTER DR
Provider Second Line Business Practice Location Address:
RM 9N224
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20892-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-761-7670
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0024170096 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AC001925 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1194870311 . This is a "GROUP NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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