Provider Demographics
NPI:1043975527
Name:MOGEL, LAURA GARRETT (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:GARRETT
Last Name:MOGEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:ROCHELLE
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 742921
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2921
Mailing Address - Country:US
Mailing Address - Phone:804-288-2742
Mailing Address - Fax:804-288-9053
Practice Address - Street 1:1011 JOHNSTON WILLIS DR STE 200
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4808
Practice Address - Country:US
Practice Address - Phone:804-288-2742
Practice Address - Fax:804-288-9053
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181740363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care