Healthcare Provider Details

I. General information

NPI: 1821372319
Provider Name (Legal Business Name): DEANNA BYNUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 JOHNSON PL
RICHMOND VA
23223-1954
US

IV. Provider business mailing address

PO BOX 1194
MECHANICSVILLE VA
23111-1194
US

V. Phone/Fax

Practice location:
  • Phone: 804-247-0600
  • Fax:
Mailing address:
  • Phone: 804-247-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: