Provider Demographics
NPI:1649640715
Name:AMISON, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:AMISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:CLAYBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1105 WALL AVE
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-6040
Mailing Address - Country:US
Mailing Address - Phone:804-451-8496
Mailing Address - Fax:
Practice Address - Street 1:1105 WALL AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-6040
Practice Address - Country:US
Practice Address - Phone:804-451-8496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle