Provider Demographics
NPI:1467535054
Name:PESNICAK, LOUISE ALICE (LNP)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:ALICE
Last Name:PESNICAK
Suffix:
Gender:F
Credentials:LNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7001
Mailing Address - Country:US
Mailing Address - Phone:757-340-4545
Mailing Address - Fax:
Practice Address - Street 1:297 INDEPENDENCE BLVD STE 126
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2836
Practice Address - Country:US
Practice Address - Phone:757-437-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP89493Medicare UPIN
VA009207C34Medicare ID - Type UnspecifiedPROVIDER NUMBER