Provider Demographics
NPI:1578803078
Name:DANIELS, W LAWRENCE (PHD, RN, CPNP)
Entity Type:Individual
Prefix:DR
First Name:W LAWRENCE
Middle Name:
Last Name:DANIELS
Suffix:
Gender:M
Credentials:PHD, RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 N CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4008
Mailing Address - Country:US
Mailing Address - Phone:757-233-0003
Mailing Address - Fax:757-233-1669
Practice Address - Street 1:6330 N CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4008
Practice Address - Country:US
Practice Address - Phone:757-233-0003
Practice Address - Fax:757-233-1669
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001128887163W00000X
VA0024128887363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010099536Medicaid
VA010099536Medicaid
VA010099536Medicaid