Healthcare Provider Details

I. General information

NPI: 1700793361
Provider Name (Legal Business Name): ALESSANDRA BAZEMORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W BROAD ST
RICHMOND VA
23284-9047
US

IV. Provider business mailing address

8067 MEADOW DR
MECHANICSVILLE VA
23111-3509
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-2647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number0001296409
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: