Healthcare Provider Details

I. General information

NPI: 1134726177
Provider Name (Legal Business Name): JULI ANN CODY NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 KEMPSVILLE CIR STE 302A
NORFOLK VA
23502-3936
US

IV. Provider business mailing address

7008 DOUMMAR DR
NORFOLK VA
23518-4808
US

V. Phone/Fax

Practice location:
  • Phone: 757-627-7301
  • Fax:
Mailing address:
  • Phone: 757-510-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024180179
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: