Healthcare Provider Details
I. General information
NPI: 1265560262
Provider Name (Legal Business Name): RECTOR AND VISITORS OF THE UNIVERSITY OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/01/2007
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1215 LEE ST
CHARLOTTESVILLE VA
22908-0816
US
IV. Provider business mailing address
PO BOX 800778
CHARLOTTESVILLE VA
22908-0778
US
V. Phone/Fax
- Phone: 434-924-8344
- Fax:
- Phone: 434-924-8344
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 367500000X |
| Taxonomy | Certified Registered Nurse Anesthetist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
WENDY
HORTON
Title or Position: CEO
Credential:
Phone: 434-243-9308