Healthcare Provider Details

I. General information

NPI: 1376017756
Provider Name (Legal Business Name): TEAM NURSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16610 RUSSELL STREET SUITE 5
ST PAUL VA
24283
US

IV. Provider business mailing address

16610 RUSSELL STREET SUITE 5
ST PAUL VA
24283
US

V. Phone/Fax

Practice location:
  • Phone: 434-575-5200
  • Fax: 434-575-5054
Mailing address:
  • Phone: 434-575-5200
  • Fax: 434-575-5054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY GLYNN
Title or Position: VP OF OPERATIONS
Credential:
Phone: 434-575-5200