Provider Demographics
NPI:1023284866
Name:GENDRON, LAURA (CRT, RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GENDRON
Suffix:
Gender:F
Credentials:CRT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8907 TRADITIONAL DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-6111
Mailing Address - Country:US
Mailing Address - Phone:804-965-9846
Mailing Address - Fax:
Practice Address - Street 1:8907 TRADITIONAL DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-6111
Practice Address - Country:US
Practice Address - Phone:804-965-9846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001211614163W00000X
VA0117004384227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified