Provider Demographics
NPI:1093350472
Name:SHIELDS, LAURA ELIZABETH HOUGH (NP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELIZABETH HOUGH
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-757-6738
Mailing Address - Fax:757-483-9350
Practice Address - Street 1:3802 POPLAR HILL RD STE C
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5523
Practice Address - Country:US
Practice Address - Phone:757-673-8383
Practice Address - Fax:757-483-9350
Is Sole Proprietor?:No
Enumeration Date:2019-11-09
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0001230792163W00000X
VAL-104779163WL0100X
390200000X
VA0024178775363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program