Healthcare Provider Details

I. General information

NPI: 1437411907
Provider Name (Legal Business Name): OCTAVIA SIEGEL-HAWLEY SCHLUETER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OCTAVIA KENDALL SIEGEL HAWLEY

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 LIBBIE AVE STE 200
RICHMOND VA
23226-2618
US

IV. Provider business mailing address

9407 CUMBERLAND RD
NEW KENT VA
23124-2029
US

V. Phone/Fax

Practice location:
  • Phone: 434-202-4080
  • Fax: 844-705-0170
Mailing address:
  • Phone: 804-966-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0017140020
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: