Healthcare Provider Details

I. General information

NPI: 1821455320
Provider Name (Legal Business Name): ALEXIA WALLACE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIA NIEVES

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E HUNDRED RD
CHESTER VA
23836-2613
US

IV. Provider business mailing address

221 E HUNDRED RD
CHESTER VA
23836-2613
US

V. Phone/Fax

Practice location:
  • Phone: 804-530-1172
  • Fax:
Mailing address:
  • Phone: 804-530-1172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9287652
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174328
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: