Healthcare Provider Details

I. General information

NPI: 1518460922
Provider Name (Legal Business Name): LAUREN CHAZNEY BOSS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN C BOSS

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 8630B
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR STE 8630B
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6115
  • Fax:
Mailing address:
  • Phone: 757-388-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-167405
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11001682
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024181731
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024181731
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024181731
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: