Healthcare Provider Details

I. General information

NPI: 1073141602
Provider Name (Legal Business Name): MADELINE OLIVIA SCIPIONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 ROBIOUS RD STE 100
MIDLOTHIAN VA
23113-5605
US

IV. Provider business mailing address

10281 BRICKERTON DR
MECHANICSVILLE VA
23116-5847
US

V. Phone/Fax

Practice location:
  • Phone: 804-379-9494
  • Fax:
Mailing address:
  • Phone: 540-533-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001266527
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024182948
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: