Healthcare Provider Details

I. General information

NPI: 1699707455
Provider Name (Legal Business Name): GAIL LAVENE DUSSERE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAVENE GAIL DUSSERE

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W BANK ST SUITE 6
PETERSBURG VA
23803-3279
US

IV. Provider business mailing address

11117 CUTBANK CHURCH RD
MC KENNEY VA
23872-2411
US

V. Phone/Fax

Practice location:
  • Phone: 804-862-8002
  • Fax: 804-862-8023
Mailing address:
  • Phone: 804-478-4936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001078852
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: