Provider Demographics
NPI:1588065999
Name:MCSHANE, LAURIE L (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:L
Last Name:MCSHANE
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23191 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:ACCOMACK
Mailing Address - State:VA
Mailing Address - Zip Code:23301
Mailing Address - Country:US
Mailing Address - Phone:757-787-5842
Mailing Address - Fax:757-787-5841
Practice Address - Street 1:23191 FRONT STREET
Practice Address - Street 2:
Practice Address - City:ACCOMAC
Practice Address - State:VA
Practice Address - Zip Code:23301
Practice Address - Country:US
Practice Address - Phone:757-787-5842
Practice Address - Fax:757-787-5841
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169238367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife