Healthcare Provider Details

I. General information

NPI: 1093350472
Provider Name (Legal Business Name): LAURA ELIZABETH HOUGH SHIELDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2019
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 POPLAR HILL RD STE C
CHESAPEAKE VA
23321-5523
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707-0068
US

V. Phone/Fax

Practice location:
  • Phone: 757-673-8383
  • Fax: 757-483-9350
Mailing address:
  • Phone: 757-757-6738
  • Fax: 757-483-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001230792
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-104779
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024178775
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: