Healthcare Provider Details

I. General information

NPI: 1578803078
Provider Name (Legal Business Name): W LAWRENCE DANIELS PHD, RN, CPNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BRUTON CT STE C
CHESAPEAKE VA
23322-4377
US

IV. Provider business mailing address

4583 HIALEAH DR
VIRGINIA BEACH VA
23464-3220
US

V. Phone/Fax

Practice location:
  • Phone: 757-410-2644
  • Fax:
Mailing address:
  • Phone: 757-681-4621
  • Fax: 757-455-5238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024128887
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024128887
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001128887
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: