Healthcare Provider Details

I. General information

NPI: 1851917298
Provider Name (Legal Business Name): JARAE NASHOUWN WARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 MAGIC HOLLOW BLVD
VIRGINIA BEACH VA
23453-3010
US

IV. Provider business mailing address

2056 MILLVILLE RD
CHESAPEAKE VA
23323-5309
US

V. Phone/Fax

Practice location:
  • Phone: 757-639-2218
  • Fax: 866-594-3899
Mailing address:
  • Phone: 317-410-4757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-124667
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: