Healthcare Provider Details

I. General information

NPI: 1558834853
Provider Name (Legal Business Name): HELEN BALMACEDA DUDLEY BURRELL NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 W MERCURY BLVD
HAMPTON VA
23669-2508
US

IV. Provider business mailing address

49 W MERCURY BLVD
HAMPTON VA
23669-2508
US

V. Phone/Fax

Practice location:
  • Phone: 757-269-9980
  • Fax: 757-330-0770
Mailing address:
  • Phone: 757-269-9980
  • Fax: 757-330-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001224788
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024177010
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: