Healthcare Provider Details

I. General information

NPI: 1558871772
Provider Name (Legal Business Name): MS. MELODY YVONNE KIRVEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 POLLOCK ST
RICHMOND VA
23222-2849
US

IV. Provider business mailing address

612 POLLOCK ST
RICHMOND VA
23222-2849
US

V. Phone/Fax

Practice location:
  • Phone: 804-274-9719
  • Fax: 804-321-7654
Mailing address:
  • Phone: 804-274-9719
  • Fax: 804-321-7654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: