Healthcare Provider Details

I. General information

NPI: 1194272302
Provider Name (Legal Business Name): MEGAN ZOLTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 W BROAD ST STE 300
RICHMOND VA
23230-1710
US

IV. Provider business mailing address

1000 BOULDERS PKWY STE 102
NORTH CHESTERFIELD VA
23225-5515
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-4243
  • Fax: 804-622-0552
Mailing address:
  • Phone: 804-320-4243
  • Fax: 804-622-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024173890
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: