Healthcare Provider Details

I. General information

NPI: 1306362025
Provider Name (Legal Business Name): JODY CHANCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 MASON AVE
CAPE CHARLES VA
23310-3200
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD STE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-331-1422
  • Fax: 757-331-1624
Mailing address:
  • Phone: 757-316-5900
  • Fax: 757-534-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175223
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: