Basic Information
Provider Information
NPI: 1225095813
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TURNER
FirstName: LOU
MiddleName: ANNE
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2000 MEADE PKWY
Address2:  
City: SUFFOLK
State: VA
PostalCode: 234344259
CountryCode: US
TelephoneNumber: 7575390251
FaxNumber: 7575397523
Practice Location
Address1: 2000 MEADE PKWY
Address2:  
City: SUFFOLK
State: VA
PostalCode: 234344259
CountryCode: US
TelephoneNumber: 7575390251
FaxNumber: 7575397523
Other Information
ProviderEnumerationDate: 04/27/2006
LastUpdateDate: 05/14/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X0017000969VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

ID Information
IDTypeStateIssuerDescription
778320505VA MEDICAID
50000870001VARAILROAD MEDICAREOTHER


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