Healthcare Provider Details

I. General information

NPI: 1871235705
Provider Name (Legal Business Name): JENNA ELISE FRAWLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST
RICHMOND VA
23298-0163
US

IV. Provider business mailing address

PO BOX 980102
RICHMOND VA
23298-0102
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-6685
  • Fax:
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101288606
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101288606
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: