Healthcare Provider Details

I. General information

NPI: 1760071930
Provider Name (Legal Business Name): MICHELLE ELAINE DEANES FNP ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BATTLEFIELD BLVD N # BLVEN
CHESAPEAKE VA
23320-4941
US

IV. Provider business mailing address

131 TULIP TREE DR
CAMDEN NC
27921-8330
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-9388
  • Fax: 757-490-9401
Mailing address:
  • Phone: 252-619-1456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024180458
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024180458
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: