Healthcare Provider Details

I. General information

NPI: 1407257702
Provider Name (Legal Business Name): JENNIFER WILLIAMSON CUCHNA ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2014
Last Update Date: 09/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 CONCERT DR
VIRGINIA BEACH VA
23456-8082
US

IV. Provider business mailing address

2827 BEACHMONT AVE
NORFOLK VA
23504-3707
US

V. Phone/Fax

Practice location:
  • Phone: 757-708-4425
  • Fax:
Mailing address:
  • Phone: 919-244-9527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126002002
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: