Healthcare Provider Details

I. General information

NPI: 1275790412
Provider Name (Legal Business Name): NORTHERN NECK FREE HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 WILLIAM B GRAHAM CT
KILMARNOCK VA
22482-3852
US

IV. Provider business mailing address

51 WILLIAM B GRAHAM CT
KILMARNOCK VA
22482-3852
US

V. Phone/Fax

Practice location:
  • Phone: 804-435-0575
  • Fax:
Mailing address:
  • Phone: 804-435-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROSALYN JEAN NELSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 804-435-0575