Provider Demographics
NPI:1063988186
Name:GLEIBERMAN, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GLEIBERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:GLEIBERMAN
Other - Last Name:HELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 N BEAUREGARD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1732
Mailing Address - Country:US
Mailing Address - Phone:703-717-4148
Mailing Address - Fax:703-717-4149
Practice Address - Street 1:1600 N BEAUREGARD ST STE 300
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1732
Practice Address - Country:US
Practice Address - Phone:703-717-4148
Practice Address - Fax:703-717-4149
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1037756363LF0000X
VA0024183633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily