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NPI Code Detail

MEDICARE: BLUE HARBOR OASIS LLC

MEDICARE: BLUE HARBOR OASIS LLC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner
2363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1417754813
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE HARBOR OASIS LLC
Provider Business Mailing Address
First Line : 9200 STONY POINT PKWY STE 151A
Second Line :
City : RICHMOND
State : VA
Zip : 23235-1976
Country : US
Telephone Number : 804-610-4588
Fax Number : 804-415-8308
Provider Business Practice Location Address
First Line : 9200 STONY POINT PKWY STE 151A
Second Line :
City : RICHMOND
State : VA
Zip : 23235-1976
Country : US
Telephone Number : 804-610-4588
Fax Number : 804-415-8308
Authorized Official
Title or Position : FAMILY NURSE PRACTITIONER
Name : CRYSTAL LASHAWN EALY
Credential :
Telephone Number : 804-795-2137
Provider Enumeration Date : 02/25/2025
Last Update Date : 12/08/2025

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Directions to “BLUE HARBOR OASIS LLC ” Practice Location

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