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NPI Code Detail

MEDICARE: LEELAWATTIE BISNAUTH NURSE PRACTITIONER

MEDICARE:   LEELAWATTIE  BISNAUTH  NURSE PRACTITIONER
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
1363LF0000XFamily Nurse Practitioner0024181123VA

General Provider Information

NPI Number : 1912583337
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEELAWATTIE BISNAUTH NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 856 J CLYDE MORRIS BLVD STE A
Second Line :
City : NEWPORT NEWS
State : VA
Zip : 23601-1318
Country : US
Telephone Number : 757-316-5800
Fax Number : 757-534-5190
Provider Business Practice Location Address
First Line : 209 VILLAGE AVE STE P
Second Line :
City : YORKTOWN
State : VA
Zip : 23693-5639
Country : US
Telephone Number : 757-316-5050
Fax Number : 757-369-2999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2021
Last Update Date : 08/16/2021

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Directions to “ LEELAWATTIE BISNAUTH NURSE PRACTITIONER” Practice Location

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