Individual provider Active NPI

Laura Leigh Wolok, R.D., C.D.E.

  • Diabetes Educator Registered Nurse
  • Fairfax, VA
National Provider Identifier
1184954539
Registry record updated Oct 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diabetes Educator Registered NurseTaxonomy code 163WD0400X
License
20320510 Issued in VA
Practice address
2740 Prosperity Ave Ste 200
Fairfax, VA 22031-4354
Phone
(877) 511-4625
Fax
(703) 204-9006
NPI assigned
Jan 7, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X
Diabetes Educator Registered Nurse 163WD0400X 20320510 VA Primary

Addresses

Primary practice location

2740 Prosperity Ave Ste 200
Fairfax, VA 22031-4354

Mailing address

2740 Prosperity Ave Ste 200
Fairfax, VA 22031-4354
Phone (877) 511-4625

Other practice location 1

2700 Prosperity Ave Ste 100
Fairfax, VA 22031-4340
Phone (703) 698-2505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20141031001095 DC Practitioner - Registered Dietitian Or Nutrition Professional 1658592894 Reassigns benefits to 1 organization
I20150205002361 VA Practitioner - Registered Dietitian Or Nutrition Professional 1658592894 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
20320510VAMDDiabetes Educator Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Inova Health Care Services CurrentSince Sep 1, 2014 Accepting new patients

Locations

4320 Seminary Rd
Alexandria, VA 22304
Phone (703) 504-3000

43490 Yukon Dr
Ste 204
Ashburn, VA 20147
Phone (571) 665-6960

2740 Prosperity Ave
Ste 200
Fairfax, VA 22031
Phone (703) 208-2273

2700 Prosperity Ave
Ste 100
Fairfax, VA 22031
Phone (703) 698-2505

3300 Gallows Rd
Falls Church, VA 22042
Phone (703) 352-9395

224B Cornwall St NW
Leesburg, VA 20176
Phone (703) 771-2894

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1184954539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 PROSPERITY AVE STE 200",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314354",
            "telephone_number": "877-511-4625",
            "fax_number": "703-204-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 PROSPERITY AVE STE 200",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314354",
            "telephone_number": "877-511-4625",
            "fax_number": "703-204-9006"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2700 Prosperity Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220314340",
            "country_code": "US",
            "telephone_number": "703-698-2505",
            "fax_number": "703-698-2506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOLOK",
        "first_name": "LAURA",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "R.D., C.D.E.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-07",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "VA",
            "license": "20320510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.