Healthcare Provider Details

I. General information

NPI: 1427526532
Provider Name (Legal Business Name): NICOLE UNDERDUE MORTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 BRADFORD DR
SUFFOLK VA
23435-2001
US

IV. Provider business mailing address

5925 BRADFORD DR
SUFFOLK VA
23435-2001
US

V. Phone/Fax

Practice location:
  • Phone: 757-926-9245
  • Fax:
Mailing address:
  • Phone: 757-926-9245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MORTON
Title or Position: OWNER
Credential:
Phone: 757-926-9245