Healthcare Provider Details

I. General information

NPI: 1548015373
Provider Name (Legal Business Name): MONCHEA SHANELLE TURNER NAIL TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 BRUCE ST
NORFOLK VA
23513-2710
US

IV. Provider business mailing address

4815 BRUCE ST
NORFOLK VA
23513-2710
US

V. Phone/Fax

Practice location:
  • Phone: 757-737-9881
  • Fax:
Mailing address:
  • Phone: 757-737-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: