Provider Demographics
NPI:1992061642
Name:MIDDLETON, LAURA ANN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12585 FAIR LAKES CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3822
Mailing Address - Country:US
Mailing Address - Phone:703-222-0173
Mailing Address - Fax:703-865-7450
Practice Address - Street 1:12585 FAIR LAKES CIR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3822
Practice Address - Country:US
Practice Address - Phone:703-222-0173
Practice Address - Fax:703-865-7450
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166733363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health