1386923837 NPI number — MS. LAURA CHRISTINE WANNALL NURSE

Table of content: MS. LAURA CHRISTINE WANNALL NURSE (NPI 1386923837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386923837 NPI number — MS. LAURA CHRISTINE WANNALL NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANNALL
Provider First Name:
LAURA
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386923837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1012 EASTBOURNE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAPLATA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-416-3508
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1012 EASTBOURNE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PLATA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20646-3562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-416-3508
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  R107921 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com