Healthcare Provider Details

I. General information

NPI: 1073169348
Provider Name (Legal Business Name): KATHERINE CHANDLER QUICKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 STONY POINT DR
RICHMOND VA
23235-1979
US

IV. Provider business mailing address

9101 STONY POINT DR
RICHMOND VA
23235-1979
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-9105
  • Fax:
Mailing address:
  • Phone: 804-330-9105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024177776
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: