Healthcare Provider Details

I. General information

NPI: 1912629486
Provider Name (Legal Business Name): CHARISE VILFRARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 KING ST., #237 STE. 200
ALEXANDRIA VA
22314
US

IV. Provider business mailing address

4101 SNOWBIRD CIR
ROANOKE VA
24018-4852
US

V. Phone/Fax

Practice location:
  • Phone: 434-266-9868
  • Fax:
Mailing address:
  • Phone: 434-266-9868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001282836
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0001282836
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number0001282836
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number0001282836
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number0001282836
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001282836
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number0001282836
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number0001282836
License Number StateVA
# 9
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: