Provider Demographics
NPI:1508948324
Name:NIEWENHOUS, LAURA C (CRNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:NIEWENHOUS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 STONELEIGH CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-9751
Mailing Address - Country:US
Mailing Address - Phone:301-494-0874
Mailing Address - Fax:
Practice Address - Street 1:134 OWENSVILLE RD
Practice Address - Street 2:
Practice Address - City:WEST RIVER
Practice Address - State:MD
Practice Address - Zip Code:20778-9998
Practice Address - Country:US
Practice Address - Phone:410-867-4700
Practice Address - Fax:410-867-4934
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR062554363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS81726Medicare UPIN
MDH601349YMedicare ID - Type Unspecified