Healthcare Provider Details

I. General information

NPI: 1942757265
Provider Name (Legal Business Name): CATHERINE DARE ADICKES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 GODWIN BLVD STE 305
SUFFOLK VA
23434-8158
US

IV. Provider business mailing address

2790 GODWIN BLVD STE 305
SUFFOLK VA
23434-8158
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-4222
  • Fax: 757-434-4111
Mailing address:
  • Phone: 757-934-4222
  • Fax: 757-434-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001203687
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174097
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: