Healthcare Provider Details

I. General information

NPI: 1477523041
Provider Name (Legal Business Name): DIANA G LAING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4893 EUCLID RD.
VIRGINIA BEACH VA
23462
US

IV. Provider business mailing address

4893 EUCLID RD
VIRGINIA BEACH VA
23462-3857
US

V. Phone/Fax

Practice location:
  • Phone: 757-497-1296
  • Fax:
Mailing address:
  • Phone: 757-497-1296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001035180
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: