Healthcare Provider Details

I. General information

NPI: 1497090633
Provider Name (Legal Business Name): EBONY WILLIAMS POINDEXTER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 N LYNNHAVEN RD SUITE 107
VIRGINIA BEACH VA
23452-7514
US

IV. Provider business mailing address

2124 WHITLEY ABBEY DR
VIRGINIA BEACH VA
23456-5753
US

V. Phone/Fax

Practice location:
  • Phone: 757-340-5814
  • Fax:
Mailing address:
  • Phone: 757-749-2209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number919643436
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: