Healthcare Provider Details

I. General information

NPI: 1629845177
Provider Name (Legal Business Name): MELISSA GAIL ANDERSON RN, BSN, CHPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 VISTA CENTRE DR STE 14
FOREST VA
24551-2786
US

IV. Provider business mailing address

110 VISTA CENTRE DR STE 14
FOREST VA
24551-2786
US

V. Phone/Fax

Practice location:
  • Phone: 540-816-9139
  • Fax: 434-818-0910
Mailing address:
  • Phone: 540-816-9139
  • Fax: 434-818-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number0001258980
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001258980
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0001258980
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: