Healthcare Provider Details

I. General information

NPI: 1750455929
Provider Name (Legal Business Name): DONNA LAUE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 N JEFFERSON ST STE C
ALBANY GA
31701-5117
US

IV. Provider business mailing address

803 N JEFFERSON ST STE A
ALBANY GA
31701-5117
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-5800
  • Fax: 229-312-5853
Mailing address:
  • Phone: 229-312-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN095679
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: