Healthcare Provider Details

I. General information

NPI: 1124574777
Provider Name (Legal Business Name): VIRGINIA CAROLINE BOARDWINE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 10/06/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 DANTE ROAD
ST. PAUL VA
24283-3658
US

IV. Provider business mailing address

276 FIELDSTONE DR
JONESVILLE VA
24263-1215
US

V. Phone/Fax

Practice location:
  • Phone: 276-467-2201
  • Fax:
Mailing address:
  • Phone: 276-546-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024173795
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: