Healthcare Provider Details

I. General information

NPI: 1346451093
Provider Name (Legal Business Name): MARY ELLEN TORMEY RN, NP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 S MAIN ST
FARMVILLE VA
23901-2301
US

IV. Provider business mailing address

1522 RAYBURN RD
NORTH CHESTERFIELD VA
23235-6233
US

V. Phone/Fax

Practice location:
  • Phone: 434-315-3757
  • Fax:
Mailing address:
  • Phone: 412-334-5315
  • Fax: 877-331-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP010273
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN 235426
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024170896
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: