Healthcare Provider Details

I. General information

NPI: 1568421535
Provider Name (Legal Business Name): MARY JUDITH PILCHER WHP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10243 ROGERS DRIVE
NASSAWADOX VA
23413
US

IV. Provider business mailing address

PO BOX 836
NASSAWADOX VA
23413-0836
US

V. Phone/Fax

Practice location:
  • Phone: 757-442-6719
  • Fax: 757-442-7375
Mailing address:
  • Phone: 757-442-6719
  • Fax: 757-442-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024090211
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: