Healthcare Provider Details

I. General information

NPI: 1871501585
Provider Name (Legal Business Name): SHEILA B PONDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9891 GENERAL PULLER HWY
HARTFIELD VA
23071-3122
US

IV. Provider business mailing address

PO BOX 2255
KILMARNOCK VA
22482-2255
US

V. Phone/Fax

Practice location:
  • Phone: 804-776-9221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024146489
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: