Healthcare Provider Details

I. General information

NPI: 1952555435
Provider Name (Legal Business Name): KRISTIE SHANTEL MCNEIL-OLIVER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

3917 SALDALE DR
RICHMOND VA
23237-1412
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5000
  • Fax:
Mailing address:
  • Phone: 804-743-9805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number0001202254
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: