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NPI Code Detail

MEDICARE: ALINE MARIE BASS LPN

MEDICARE: ALINE MARIE BASS LPN
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
1164W00000XLicensed Practical Nurse0002095397VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10002095397OTHERVALPN

General Provider Information

NPI Number : 1912570078
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALINE MARIE BASS LPN
Provider Business Mailing Address
First Line : 1728 VIRGINIA BEACH BLVD
Second Line : SUITE 113
City : VIRGINIA BEACH
State : VA
Zip : 23454
Country : US
Telephone Number : 757-437-0411
Fax Number : 757-552-0378
Provider Business Practice Location Address
First Line : 1728 VIRGINIA BEACH BLVD STE 113
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-4533
Country : US
Telephone Number : 757-437-0411
Fax Number : 757-552-0378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2021
Last Update Date : 08/10/2021

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