Provider Demographics
NPI:1457455776
Name:TRAIL, LAURENCE LEE (NP)
Entity Type:Individual
Prefix:MR
First Name:LAURENCE
Middle Name:LEE
Last Name:TRAIL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 HORNELL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-3770
Mailing Address - Country:US
Mailing Address - Phone:301-421-9115
Mailing Address - Fax:202-745-2283
Practice Address - Street 1:1126 HORNELL DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-3770
Practice Address - Country:US
Practice Address - Phone:301-421-9115
Practice Address - Fax:202-745-2283
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR083369363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health