Healthcare Provider Details

I. General information

NPI: 1598818213
Provider Name (Legal Business Name): ORAKAE MASON TROTTER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ORAKAE M MASON R.N.

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W BANK ST
PETERSBURG VA
23803-3279
US

IV. Provider business mailing address

4312 MCILWAINE DR
PETERSBURG VA
23803-9412
US

V. Phone/Fax

Practice location:
  • Phone: 804-862-8003
  • Fax: 804-863-4049
Mailing address:
  • Phone: 804-862-8003
  • Fax: 804-863-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001184144
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: