Healthcare Provider Details

I. General information

NPI: 1386640134
Provider Name (Legal Business Name): CLAIRE LOUISE LAURENZA MSN, APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11870 SUNRISE VALLEY DR STE 200
RESTON VA
20191-3303
US

IV. Provider business mailing address

2032 ROYAL FERN CT. 1-A
RESTON VA
20191-2032
US

V. Phone/Fax

Practice location:
  • Phone: 703-598-8402
  • Fax: 703-391-7381
Mailing address:
  • Phone: 703-598-8402
  • Fax: 703-391-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0001093793
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0015000179
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: