Healthcare Provider Details

I. General information

NPI: 1740233618
Provider Name (Legal Business Name): JULIA ANN MCKINNIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 PINEY FOREST RD
DANVILLE VA
24540-1606
US

IV. Provider business mailing address

313 VIRGINIA AVE
DANVILLE VA
24541-3729
US

V. Phone/Fax

Practice location:
  • Phone: 434-836-3072
  • Fax: 434-836-3073
Mailing address:
  • Phone: 434-770-8752
  • Fax: 434-836-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number0001136083
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: