Healthcare Provider Details

I. General information

NPI: 1730305194
Provider Name (Legal Business Name): NANCY JUAN DEMBICER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7238 MECHANICSVILLE TPKE
MECHANICSVILLE VA
23111-3502
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 804-559-9900
  • Fax:
Mailing address:
  • Phone: 804-968-5700
  • Fax: 804-217-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110840680
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: