Healthcare Provider Details

I. General information

NPI: 1821474412
Provider Name (Legal Business Name): DEDE E ECHITEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5483 MOORETOWN RD
WILLIAMSBURG VA
23188-2108
US

IV. Provider business mailing address

4849 RONSON CT STE 217
SAN DIEGO CA
92111-1805
US

V. Phone/Fax

Practice location:
  • Phone: 757-941-6400
  • Fax: 757-565-0620
Mailing address:
  • Phone: 858-279-1212
  • Fax: 858-279-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172750
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403717
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01435100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: