Healthcare Provider Details

I. General information

NPI: 1073363008
Provider Name (Legal Business Name): DEVONNA MARIE DYSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N LAKE LOOP
HAMPTON VA
23666-5560
US

IV. Provider business mailing address

110 COLISEUM XING # 3570
HAMPTON VA
23666-5971
US

V. Phone/Fax

Practice location:
  • Phone: 757-818-0213
  • Fax: 757-703-1528
Mailing address:
  • Phone: 757-818-0213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number001241631
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: