Healthcare Provider Details

I. General information

NPI: 1407772981
Provider Name (Legal Business Name): DEMETRIA MANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 TWIN HICKORY RD
GLEN ALLEN VA
23059-5682
US

IV. Provider business mailing address

PO BOX 74244
NORTH CHESTERFIELD VA
23236-0005
US

V. Phone/Fax

Practice location:
  • Phone: 804-441-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024197884
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: