Provider Demographics
NPI:1699869578
Name:TERRY, LAURA P (CRNA)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:P
Last Name:TERRY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:E
Other - Last Name:PARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:68 S SERVICE RD
Mailing Address - Street 2:STE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2358
Mailing Address - Country:US
Mailing Address - Phone:516-945-3107
Mailing Address - Fax:
Practice Address - Street 1:3998 FAIR RIDGE DR.
Practice Address - Street 2:SUITE 320
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2921
Practice Address - Country:US
Practice Address - Phone:703-391-3129
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166846367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1699869578Medicaid
VA484645OtherNCPPO
DCK142-0002OtherCAREFIRST
DCK142-0002OtherCAREFIRST
VA010155F81Medicare PIN
VA010155F81Medicare ID - Type Unspecified