Healthcare Provider Details

I. General information

NPI: 1487099750
Provider Name (Legal Business Name): MELISSA COTTEE REAGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA M. COTTEE

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7544 MEDICAL DR SUITE B
GLOUCESTER VA
23061-4299
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD SUITE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 804-693-9037
  • Fax: 804-693-9486
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024170827
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: