Provider Demographics
NPI:1467444232
Name:LAU, GIAVANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:GIAVANNA
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GIAVANNA
Other - Middle Name:P
Other - Last Name:BOUTHIETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:354 OLOMANA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2217
Mailing Address - Country:US
Mailing Address - Phone:402-469-0643
Mailing Address - Fax:
Practice Address - Street 1:600 CAISSON HILL RD
Practice Address - Street 2:IRWIN ARMY COMMUNITY HOSPITAL
Practice Address - City:FT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-7037
Practice Address - Country:US
Practice Address - Phone:402-469-0643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE227602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE04304OtherBLUE CROSS BLUE SHIELD NE
NE04304OtherBLUE CROSS BLUE SHIELD NE
NEH61770Medicare UPIN