Healthcare Provider Details

I. General information

NPI: 1982517884
Provider Name (Legal Business Name): JANE P IVEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE E PURYEAR RN

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14051 ST FRANCIS BLVD STE 2201
MIDLOTHIAN VA
23114-3203
US

IV. Provider business mailing address

14051 ST FRANCIS BLVD STE 2201
MIDLOTHIAN VA
23114-3203
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-2673
  • Fax: 804-639-8069
Mailing address:
  • Phone: 804-288-2673
  • Fax: 804-639-8069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number0001074731
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: