Healthcare Provider Details

I. General information

NPI: 1063074987
Provider Name (Legal Business Name): MVP CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 GUM DR
MANAKIN SABOT VA
23103-2033
US

IV. Provider business mailing address

PO BOX 31494
HENRICO VA
23294-1494
US

V. Phone/Fax

Practice location:
  • Phone: 804-241-8884
  • Fax: 804-282-9135
Mailing address:
  • Phone: 804-241-8884
  • Fax: 804-282-9135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MELISSA V PAYNE
Title or Position: OWNER/NP
Credential: NP
Phone: 804-241-8884