Provider Demographics
NPI:1396089918
Name:PACKER, LAURA (LAC, CMT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PACKER
Suffix:
Gender:F
Credentials:LAC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 AXTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-3202
Mailing Address - Country:US
Mailing Address - Phone:703-312-4650
Mailing Address - Fax:
Practice Address - Street 1:7301 AXTON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3202
Practice Address - Country:US
Practice Address - Phone:703-312-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121-000665171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist