Provider Demographics
NPI:1477899557
Name:BROOKS, LAURA D (FNP-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:BROOKS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 CLAIRMONT CT
Mailing Address - Street 2:SUITE 109
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1765
Mailing Address - Country:US
Mailing Address - Phone:180-452-6746
Mailing Address - Fax:180-452-6670
Practice Address - Street 1:436 CLAIRMONT CT
Practice Address - Street 2:SUITE 109
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1765
Practice Address - Country:US
Practice Address - Phone:180-452-6746
Practice Address - Fax:180-452-6670
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA65-1213356OtherTIN