Healthcare Provider Details

I. General information

NPI: 1841929148
Provider Name (Legal Business Name): ANGELA G FLEMING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 NUCKOLS RD
GLEN ALLEN VA
23059-5502
US

IV. Provider business mailing address

PO BOX 631863
CINCINNATI OH
45263-1863
US

V. Phone/Fax

Practice location:
  • Phone: 804-887-8322
  • Fax: 804-877-8321
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185395
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001178165
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: