Healthcare Provider Details

I. General information

NPI: 1316096886
Provider Name (Legal Business Name): DALE ROBERT FLUEGEL FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DALE ROBERT FLUEGEL DC

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 VOLVO PKWY
CHESAPEAKE VA
23320-1609
US

IV. Provider business mailing address

230 CLEARFIELD AVE SUITE 124
VIRGINIA BEACH VA
23462-1832
US

V. Phone/Fax

Practice location:
  • Phone: 757-321-3383
  • Fax: 757-321-3332
Mailing address:
  • Phone: 757-321-3383
  • Fax: 757-321-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX003442-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024168215
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335597
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168215
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: