Healthcare Provider Details

I. General information

NPI: 1154484285
Provider Name (Legal Business Name): MCDONALD ARMY HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 HERON DR
NEWPORT NEWS VA
23608-1779
US

IV. Provider business mailing address

211 HERON DR
NEWPORT NEWS VA
23608-1779
US

V. Phone/Fax

Practice location:
  • Phone: 757-224-0006
  • Fax:
Mailing address:
  • Phone: 757-224-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number0002053865
License Number StateVA

VIII. Authorized Official

Name: MRS. DENISE ARONDA CUNNINGHAM
Title or Position: LPN
Credential:
Phone: 757-314-7599