Healthcare Provider Details

I. General information

NPI: 1740901909
Provider Name (Legal Business Name): MAIREAD HARRINGTON BUSIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11958 W BROAD ST
HENRICO VA
23233-1007
US

IV. Provider business mailing address

9625 GONEWAY DR
HENRICO VA
23238-2901
US

V. Phone/Fax

Practice location:
  • Phone: 804-360-4669
  • Fax: 804-364-6521
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185109
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: