Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 0024182167 | VA |
NPI | 1063089944 |
---|---|
Provider Name | Mrs. Lauren Nicole Dotterer |
First Address | Manassas, VA 20109-5688 |
Second Address | Manassas, VA 20109-5688 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2021 |
Last Update Date | 08/11/2021 |