Healthcare Provider Details

I. General information

NPI: 1710439914
Provider Name (Legal Business Name): LAURENCE SYMENOW RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 LOY CIR
WINCHESTER VA
22602-6682
US

IV. Provider business mailing address

170 LOY CIR
WINCHESTER VA
22602-6682
US

V. Phone/Fax

Practice location:
  • Phone: 540-664-4166
  • Fax:
Mailing address:
  • Phone: 540-664-4166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001160306
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number0001160306
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number0001160306
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number0001160306
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number0001160306
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number0001160306
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number0001160306
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number0001160306
License Number StateVA
# 9
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number0001160306
License Number StateVA
# 10
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number0001160306
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: