Provider Demographics
NPI:1912068875
Name:LA FAUCI, CAROL GERARDA (NP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:GERARDA
Last Name:LA FAUCI
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1500 E LITTLE CREEK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-4137
Mailing Address - Country:US
Mailing Address - Phone:757-587-4744
Mailing Address - Fax:757-587-4947
Practice Address - Street 1:1500 E LITTLE CREEK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-4137
Practice Address - Country:US
Practice Address - Phone:757-587-4744
Practice Address - Fax:757-587-4947
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024166098363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA216803Medicare UPIN
VA005739H08Medicare ID - Type Unspecified