Healthcare Provider Details

I. General information

NPI: 1700485851
Provider Name (Legal Business Name): JOYCE S REDDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2337 SPINDRIFT RD
VIRGINIA BEACH VA
23451-1720
US

IV. Provider business mailing address

2337 SPINDRIFT RD
VIRGINIA BEACH VA
23451-1720
US

V. Phone/Fax

Practice location:
  • Phone: 757-469-3670
  • Fax:
Mailing address:
  • Phone: 757-469-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001071460
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: