Healthcare Provider Details

I. General information

NPI: 1861959033
Provider Name (Legal Business Name): LAUREN WALL COOK WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 KOGER CENTER BLVD
NORTH CHESTERFIELD VA
23235-4778
US

IV. Provider business mailing address

1212 KOGER CENTER BLVD
NORTH CHESTERFIELD VA
23235-4778
US

V. Phone/Fax

Practice location:
  • Phone: 804-897-2100
  • Fax: 804-897-9074
Mailing address:
  • Phone: 804-897-2100
  • Fax: 804-897-9074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001226022
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024177429
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: