MEDICARE: DEQWANDRA HASKINS

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	343900000X	Non-emergency Medical Transport (VAN)	A64242210	VA

General Provider Information

NPI Number	:	1548875727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEQWANDRA HASKINS

Provider Business Mailing Address
First Line	:	4900 BRYANBELL LN
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-8002
Country	:	US
Telephone Number	:	804-593-9001
Fax Number	:	804-482-2740

Provider Business Practice Location Address
First Line	:	4900 BRYANBELL LN
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-8002
Country	:	US
Telephone Number	:	804-593-9001
Fax Number	:	804-482-2740

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

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	09/14/2020

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