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General NPI Number Information
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NPI Number | 1710484886
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Entity Type | Individual
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Provider Name | LAURE CECILE GOUDIABY NP
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Gender | Female
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 3200 CRAIN HWY
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City | WALDORF
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State | MD
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Zip | 20603-4841
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Country | US
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Telephone | 301-396-9215
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Fax |
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Provider Business Mailing Address
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Address Line | 22347 CANTERFIELD WAY
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City | GERMANTOWN
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State | MD
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Zip | 20876-4375
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Country | US
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Telephone | 301-972-4117
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R194709
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License Number State | MD
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