Provider Demographics
NPI:1669804464
Name:KREISA, LAURA R (NP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:R
Last Name:KREISA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1257 MARYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6059
Mailing Address - Country:US
Mailing Address - Phone:804-741-8624
Mailing Address - Fax:804-740-3865
Practice Address - Street 1:1257 MARYWOOD LN
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-6059
Practice Address - Country:US
Practice Address - Phone:804-741-8624
Practice Address - Fax:804-740-3865
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0017141115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily