Provider Demographics
NPI:1427510213
Name:LAURIDSEN, ANGELA D (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:D
Last Name:LAURIDSEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 PLEASANT HILL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3406
Mailing Address - Country:US
Mailing Address - Phone:540-512-9754
Mailing Address - Fax:540-512-9148
Practice Address - Street 1:4800 PLEASANT HILL DR STE 102
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3406
Practice Address - Country:US
Practice Address - Phone:540-512-9754
Practice Address - Fax:540-512-9148
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002066889164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse