Healthcare Provider Details

I. General information

NPI: 1386181733
Provider Name (Legal Business Name): LYLE PURNELL MSW/LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EMANCIPATION DR BLDG 146
HAMPTON VA
23667-0001
US

IV. Provider business mailing address

100 EMANCIPATION DR BLDG 146
HAMPTON VA
23667-0001
US

V. Phone/Fax

Practice location:
  • Phone: 757-722-9961
  • Fax: 757-728-3392
Mailing address:
  • Phone: 757-722-9961
  • Fax: 757-728-3392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberLSW0000009075
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: