Healthcare Provider Details

I. General information

NPI: 1790321453
Provider Name (Legal Business Name): MRS. KATRICE M STANCIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 CRASHAW ST
VIRGINIA BEACH VA
23462-6916
US

IV. Provider business mailing address

501 VIKING DR UNIT 8302
VIRGINIA BEACH VA
23450-1259
US

V. Phone/Fax

Practice location:
  • Phone: 757-768-5856
  • Fax:
Mailing address:
  • Phone: 757-768-5856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: