Provider Demographics
NPI:1962754572
Name:SULLIVAN-SIMENSON, LAURA MARIE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MARIE
Last Name:SULLIVAN-SIMENSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10814 HEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1666
Mailing Address - Country:US
Mailing Address - Phone:540-324-7442
Mailing Address - Fax:
Practice Address - Street 1:10814 HEATHERWOOD DR
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1666
Practice Address - Country:US
Practice Address - Phone:540-324-7442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily