Healthcare Provider Details

I. General information

NPI: 1730668377
Provider Name (Legal Business Name): KRISTEN CHILTON GRABOWSKI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EXECUTIVE DR STE J
DANVILLE VA
24541-4155
US

IV. Provider business mailing address

125 EXECUTIVE DR STE J
DANVILLE VA
24541-4155
US

V. Phone/Fax

Practice location:
  • Phone: 434-797-2828
  • Fax: 434-773-6833
Mailing address:
  • Phone: 434-797-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024176665
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: