Healthcare Provider Details

I. General information

NPI: 1225242183
Provider Name (Legal Business Name): MRS. JEANNETTE STIEN BISHAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 WEST BROAD STREET
RICHMOND VA
23284
US

IV. Provider business mailing address

113 WALNUT CIRCLE
EMPORIA VA
23847
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-8828
  • Fax: 804-828-6688
Mailing address:
  • Phone: 434-348-0927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001177863
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024165836
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: