Healthcare Provider Details

I. General information

NPI: 1154080778
Provider Name (Legal Business Name): AUDREY HART M. ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 FARRAR CT
NORTH CHESTERFIELD VA
23236-3679
US

IV. Provider business mailing address

2431 KINGS LYNN RD
MIDLOTHIAN VA
23113-3813
US

V. Phone/Fax

Practice location:
  • Phone: 804-432-2833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberPGP-0682921
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: