MEDICARE: ALLIANCE HEALTHCARE, 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
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1700409547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	1308 COPPER KNOLL LN
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-3393
Country	:	US
Telephone Number	:	757-285-9591
Fax Number	:

Provider Business Practice Location Address
First Line	:	3750 SENTARA WAY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-4200
Country	:	US
Telephone Number	:	757-306-2700
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	BRANDI N COVIL
Credential	:	NP
Telephone Number	:	757-306-2700

Provider Enumeration Date	:	05/27/2020
Last Update Date	:	05/27/2020

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