Healthcare Provider Details

I. General information

NPI: 1962022392
Provider Name (Legal Business Name): GLADEVIEW MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 GLADEVIEW DR
FRIES VA
24330-3936
US

IV. Provider business mailing address

279 GLADEVIEW DR
FRIES VA
24330-3936
US

V. Phone/Fax

Practice location:
  • Phone: 276-233-7864
  • Fax:
Mailing address:
  • Phone: 276-233-7864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER RICHARDSON
Title or Position: FAMILY NURSE PRACTITIONER/OWNER
Credential: FNP-BC
Phone: 276-233-7864