Healthcare Provider Details

I. General information

NPI: 1790933349
Provider Name (Legal Business Name): MISS HEATHER C NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 ATLANTIC AVE
CHESAPEAKE VA
23324-3004
US

IV. Provider business mailing address

928 BRANDON QUAY
CHESAPEAKE VA
23320-8543
US

V. Phone/Fax

Practice location:
  • Phone: 757-543-9632
  • Fax: 757-494-1721
Mailing address:
  • Phone: 757-382-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number020201199
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: