Provider Demographics
NPI:1407369374
Name:LAYMAN, NICOLE THERESA (RN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:THERESA
Last Name:LAYMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45664 RUTHERFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:GREAT MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20634-2366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2280 OPITZ BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3362
Practice Address - Country:US
Practice Address - Phone:703-580-0436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR126918163WC0200X, 363LA2100X
VA0024175581363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine