Individual ProviderLaura P TerryNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3998 Fair Ridge Dr., Suite 320, Fairfax, VA 22033-2921(703) 391-3129(516) 945-3107PECOS EnrollmentBased on the most recent information from CMS, provider Laura P Terry does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:15 AM.Profile DetailsProvider ID1699869578Provider TypeIndividualFull NameTerry, Laura PTitleMs.CredentialCRNAGenderFemaleSole ProprietorNoEnumeration Date10/3/2006Last Updated10/31/2016Contact InformationPractice LocationPractice Address3998 Fair Ridge Dr., Suite 320, Fairfax, VA 22033-2921Phone(703) 391-3129Fax(703) 295-9369Mailing LocationMailing Address68 S Service Rd, Ste 350, Melville, NY 11747-2358Phone(516) 945-3107FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicense0024166846VirginiaProvider IdentifiersIDDescriptionIssuerID1699869578DescriptionMedicaidIssuerUnlistedVirginiaID484645DescriptionOtherIssuerNCPPOVirginiaIDK142-0002DescriptionOtherIssuerCAREFIRSTDistrict of Columbia