Healthcare Provider Details

I. General information

NPI: 1770418790
Provider Name (Legal Business Name): DAPHNEY WYATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAPHNEY NICOLE ROZHON

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

123 17TH ST SE APT #2
WASHINGTON DC
20003
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9630293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: