Provider Demographics
NPI:1043976186
Name:LAPORRE, REY BOOZ
Entity Type:Individual
Prefix:
First Name:REY BOOZ
Middle Name:
Last Name:LAPORRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7613 HUNGARY RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3290
Mailing Address - Country:US
Mailing Address - Phone:804-263-2337
Mailing Address - Fax:
Practice Address - Street 1:7613 HUNGARY RIDGE TER
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3290
Practice Address - Country:US
Practice Address - Phone:804-263-2337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179866363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care