Healthcare Provider Details

I. General information

NPI: 1477332807
Provider Name (Legal Business Name): ANGELA ZANNETTA DILLARD N/A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 WYTHE PKWY
HAMPTON VA
23661-2926
US

IV. Provider business mailing address

216 WYTHE PKWY
HAMPTON VA
23661-2926
US

V. Phone/Fax

Practice location:
  • Phone: 757-907-2756
  • Fax:
Mailing address:
  • Phone: 757-907-2756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: