Healthcare Provider Details

I. General information

NPI: 1528071743
Provider Name (Legal Business Name): LOUELLA MEACHEM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 RICHMOND HWY 200
ALEXANDRIA VA
22309-1586
US

IV. Provider business mailing address

12833 TUMBLING BROOK LN
WOODBRIDGE VA
22192-2417
US

V. Phone/Fax

Practice location:
  • Phone: 703-704-7004
  • Fax: 703-799-1053
Mailing address:
  • Phone: 703-491-5208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001101382
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: