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General NPI Number Information
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NPI Number | 1104297118
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Entity Type | Individual
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Provider Name | MARYANN C PARTRIDGE AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/16/2015
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 1714 E HUNDRED RD STE 101
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City | CHESTER
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State | VA
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Zip | 23836-3310
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Country | US
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Telephone | 804-735-4040
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Fax |
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Provider Business Mailing Address
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Address Line | 7024 STAFFORD PARK DR
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City | MOSELEY
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State | VA
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Zip | 23120-2291
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Country | US
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Telephone | 910-709-6908
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 0024173073
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001261296
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License Number State | VA
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