Basic Information
| Provider Information | |||||||||
| NPI: | 1689972812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAYMOND | ||||||||
| FirstName: | LURIANE | ||||||||
| MiddleName: | DORCELY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP: | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DORCELY | ||||||||
| OtherFirstName: | LURIANE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 16463 DAHLGREN RD | ||||||||
| Address2: | |||||||||
| City: | KING GEORGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224855810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406449505 | ||||||||
| FaxNumber: | 5406449508 | ||||||||
| Practice Location | |||||||||
| Address1: | 16463 DAHLGREN RD | ||||||||
| Address2: | |||||||||
| City: | KING GEORGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224855810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406449505 | ||||||||
| FaxNumber: | 5406449508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2011 | ||||||||
| LastUpdateDate: | 09/19/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 0024172595 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | R124825 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 0024172595 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.