Healthcare Provider Details

I. General information

NPI: 1457827362
Provider Name (Legal Business Name): MRS. CHASIDY HALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 CANVASBACK CT
NORTH DINWIDDIE VA
23803-6837
US

IV. Provider business mailing address

4405 CANVASBACK CT
NORTH DINWIDDIE VA
23803-6837
US

V. Phone/Fax

Practice location:
  • Phone: 804-721-1707
  • Fax:
Mailing address:
  • Phone: 804-721-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: