Healthcare Provider Details

I. General information

NPI: 1669630281
Provider Name (Legal Business Name): LAUREN ELISABETH HAAK ANP WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE SUITE 810
ALEXANDRIA VA
22304-1306
US

IV. Provider business mailing address

4660 KENMORE AVE SUITE 810
ALEXANDRIA VA
22304-1306
US

V. Phone/Fax

Practice location:
  • Phone: 703-823-0333
  • Fax:
Mailing address:
  • Phone: 703-823-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024167830
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024167830
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: