Healthcare Provider Details

I. General information

NPI: 1316774433
Provider Name (Legal Business Name): STEPHANIE CHADWICK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2024
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 KINGS WAY STE 2700
WILLIAMSBURG VA
23185-2554
US

IV. Provider business mailing address

120 KINGS WAY STE 2200
WILLIAMSBURG VA
23185-2507
US

V. Phone/Fax

Practice location:
  • Phone: 757-221-0110
  • Fax:
Mailing address:
  • Phone: 757-221-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024191132
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: