Healthcare Provider Details

I. General information

NPI: 1124900444
Provider Name (Legal Business Name): GLENDALEE PACHECO RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 UNIVERSITY DR
VIRGINIA BEACH VA
23453-8083
US

IV. Provider business mailing address

2009 BROOK RD APT 210
RICHMOND VA
23220-1843
US

V. Phone/Fax

Practice location:
  • Phone: 757-683-4297
  • Fax: 757-683-5253
Mailing address:
  • Phone: 413-209-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001307461
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: