Healthcare Provider Details

I. General information

NPI: 1114764065
Provider Name (Legal Business Name): JOSEPH MICHAEL BELL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12320 W BROAD ST STE 204
RICHMOND VA
23233-7603
US

IV. Provider business mailing address

1066 NORFOLK DR
LA PLATA MD
20646-3553
US

V. Phone/Fax

Practice location:
  • Phone: 804-612-2980
  • Fax:
Mailing address:
  • Phone: 443-280-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR211442
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024191433
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: