Healthcare Provider Details

I. General information

NPI: 1669568697
Provider Name (Legal Business Name): TERESA M GOLDEN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 LANGHORNE RD
LYNCHBURG VA
24501-1602
US

IV. Provider business mailing address

2542 LANGHORNE RD
LYNCHBURG VA
24501-1602
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-5297
  • Fax: 434-947-5371
Mailing address:
  • Phone: 434-947-5297
  • Fax: 434-947-5371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024166031
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: