MEDICARE: JANICE STATON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	1603177	VA

General Provider Information

NPI Number	:	1033573621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE STATON

Provider Business Mailing Address
First Line	:	2737 CAMPOSTELLA RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-3656
Country	:	US
Telephone Number	:	757-632-6824
Fax Number	:	757-689-0241

Provider Business Practice Location Address
First Line	:	2737 CAMPOSTELLA RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-3656
Country	:	US
Telephone Number	:	757-632-6824
Fax Number	:	757-689-0241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2016
Last Update Date	:	04/08/2016

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