Provider Demographics
NPI:1053453241
Name:LAGBO, ESI DANSOWA (NP)
Entity Type:Individual
Prefix:
First Name:ESI
Middle Name:DANSOWA
Last Name:LAGBO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-594-2195
Practice Address - Street 1:850 ENTERPRISE PKWY
Practice Address - Street 2:SUITE 1300
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6251
Practice Address - Country:US
Practice Address - Phone:757-637-4600
Practice Address - Fax:757-637-7641
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024167102363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00670744Medicare PIN
VAQ75529Medicare UPIN
VAMC11676Medicare PIN