Healthcare Provider Details

I. General information

NPI: 1699522995
Provider Name (Legal Business Name): ASIA ARIEL WINNINGHAM HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4828 MARKET SQUARE LN
MIDLOTHIAN VA
23112-4826
US

IV. Provider business mailing address

7325 SOUTHWIND DR APT 104
CHESTERFIELD VA
23832-1981
US

V. Phone/Fax

Practice location:
  • Phone: 804-739-0031
  • Fax:
Mailing address:
  • Phone: 804-802-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101002804
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: