Healthcare Provider Details

I. General information

NPI: 1174215867
Provider Name (Legal Business Name): BRYAN EDWARD FICHTNER FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 PINEY FOREST RD
DANVILLE VA
24540-4154
US

IV. Provider business mailing address

441 PINEY FOREST RD
DANVILLE VA
24540-4154
US

V. Phone/Fax

Practice location:
  • Phone: 434-797-4455
  • Fax:
Mailing address:
  • Phone: 434-797-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024187148
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: