Provider Demographics
NPI:1790132330
Name:LAURELL, DAVIN NICOLAS (SURFACE FORCE IDC)
Entity Type:Individual
Prefix:MR
First Name:DAVIN
Middle Name:NICOLAS
Last Name:LAURELL
Suffix:
Gender:M
Credentials:SURFACE FORCE IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HELICOPTER RD BLDG 3854
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23459-8913
Mailing Address - Country:US
Mailing Address - Phone:757-756-6749
Mailing Address - Fax:
Practice Address - Street 1:1300 HELICOPTER RD BLDG 3854
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459-8913
Practice Address - Country:US
Practice Address - Phone:757-756-6749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman