Provider Demographics
NPI:1184307233
Name:WILEY, LAURYN MARSHAY (CD)
Entity type:Individual
Prefix:
First Name:LAURYN
Middle Name:MARSHAY
Last Name:WILEY
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 MADISON ST APT A1
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-3270
Mailing Address - Country:US
Mailing Address - Phone:540-993-2025
Mailing Address - Fax:
Practice Address - Street 1:603 MADISON ST APT A1
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-3270
Practice Address - Country:US
Practice Address - Phone:540-993-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA6492374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula