Provenzano, Laura

Provenzano, Laura is an sole proprietor health care provider with primary practice located at 3117 Duke St , Alexandria VA 22314-4518. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Provenzano, Laura can be contacted via phone (703) 751-8800.

Contact Information

Primary practice address
3117 Duke St Alexandria VA 22314-4518
Phone: (703) 751-8800
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0110004424 Virginia

Profile Details

NPI number 1396080800
LBN Legal business name Provenzano, Laura
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 10th, 2012
Last updated Dec 12th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396080800 NPPES
Virginia Other 0110004424 STATE LICENSE

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