Basic Information
| Provider Information | |||||||||
| NPI: | 1104087147 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARNER | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235010936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465908 | ||||||||
| FaxNumber: | 7574465970 | ||||||||
| Practice Location | |||||||||
| Address1: | 855 W BRAMBLETON AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235101005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465908 | ||||||||
| FaxNumber: | 7574465970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2008 | ||||||||
| LastUpdateDate: | 06/12/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024167754 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | PAR | 01 | VA | CORVEL/CORCARE | OTHER | -033 | 01 | VA | TRICARE/CHAMPUS | OTHER | 10039269N | 01 | VA | SENTARA/OPTIMA | OTHER | PAR | 01 | VA | VA PREMIER HEALTH | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | 7004430 | 05 | NC | MEDICAID | PAR | 01 | VA | USA MANAGED CARE | OTHER | 04430 | 01 | NC | BC/BS OF NORTH CAROLINA | OTHER | 1104087147 | 05 | VA | MEDICAID |