Provider Demographics
NPI:1649511213
Name:LAWANI, BERTHA OSAIGBOKAN (NP-C)
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:OSAIGBOKAN
Last Name:LAWANI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:656 INDEPENDENCE PKWY
Practice Address - Street 2:SUIT 200
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5213
Practice Address - Country:US
Practice Address - Phone:757-410-3630
Practice Address - Fax:757-410-3631
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAF1012351363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner