Healthcare Provider Details

I. General information

NPI: 1699077057
Provider Name (Legal Business Name): PRIVATE DUTY RN OF WARSAW, VA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 DELFAE DR
WARSAW VA
22572-4290
US

IV. Provider business mailing address

127 DELFAE DR
WARSAW VA
22572-4290
US

V. Phone/Fax

Practice location:
  • Phone: 804-333-1488
  • Fax:
Mailing address:
  • Phone: 804-333-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001151398
License Number StateVA

VIII. Authorized Official

Name: JANNA KAY STALLINGS
Title or Position: RN
Credential:
Phone: 804-333-1488