Healthcare Provider Details

I. General information

NPI: 1841169893
Provider Name (Legal Business Name): NAN TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 WINDY RIDGE TER
MIDLOTHIAN VA
23112-6341
US

IV. Provider business mailing address

5510 WINDY RIDGE TER
MIDLOTHIAN VA
23112-6341
US

V. Phone/Fax

Practice location:
  • Phone: 804-912-5578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: DR. KALKIDAN SHIMELIS DESTA
Title or Position: OWNER/ADMINISTRATOR
Credential: REV. DR.
Phone: 804-912-5578