Healthcare Provider Details

I. General information

NPI: 1255065488
Provider Name (Legal Business Name): NICHOLAS DANIEL SANTALUCIA LNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 E PARHAM RD
RICHMOND VA
23228-2368
US

IV. Provider business mailing address

3811 E WEYBURN RD
RICHMOND VA
23235-2037
US

V. Phone/Fax

Practice location:
  • Phone: 855-444-9838
  • Fax:
Mailing address:
  • Phone: 804-519-9483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberPENDING
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: