Healthcare Provider Details

I. General information

NPI: 1033295092
Provider Name (Legal Business Name): TEAM NURSE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N. MAIN STREET
STUART VA
24171
US

IV. Provider business mailing address

PO BOX 776
SOUTH BOSTON VA
24592-0776
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-4406
  • Fax: 276-694-4727
Mailing address:
  • Phone: 434-575-5200
  • Fax: 434-575-5204

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 NumberHCO-10289
License Number StateVA
# 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: MR. STEVEN D. MIZE
Title or Position: PRESIDENT
Credential:
Phone: 434-575-5200