Provider Demographics
NPI:1386640134
Name:LAURENZA, CLAIRE LOUISE (MSN, APRN,BC)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:LOUISE
Last Name:LAURENZA
Suffix:
Gender:F
Credentials:MSN, APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 ROYAL FERN CT.
Mailing Address - Street 2:1-A
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-2032
Mailing Address - Country:US
Mailing Address - Phone:703-598-8402
Mailing Address - Fax:703-391-7381
Practice Address - Street 1:11870 SUNRISE VALLEY DR
Practice Address - Street 2:STE 200
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3303
Practice Address - Country:US
Practice Address - Phone:703-598-8402
Practice Address - Fax:703-391-7381
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001093793163WP0809X
VA0015000179163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7070119OtherAETNA NUMBER
VAJ3170001OtherCAREFIRST BC NUMBER
VA059009OtherANTHEM BC/BS
VA255174000OtherMAGELLAN NUMBER
VA794805Medicare ID - Type UnspecifiedMEDICARE NUMBER