MEDICARE: MS. CECILIA Y LAU RN, MS, APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	R059883	MD

General Provider Information

NPI Number	:	1649506387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CECILIA Y LAU RN, MS, APRN

Provider Business Mailing Address
First Line	:	604 S FREDERICK AVE,
Second Line	:	SUITE 213
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-1282
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 S FREDERICK AVE,
Second Line	:	SUITE 213
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-1282
Country	:	US
Telephone Number	:	240-489-7448
Fax Number	:	301-355-6614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2009
Last Update Date	:	04/20/2012

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