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General NPI Number Information
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NPI Number | 1174410039
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Entity Type | Organization
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Legal Business Name | IMPERFECTIONS HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 2225 ADMIRAL CIR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-1733
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Country | US
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Telephone | 757-722-9961
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Fax |
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Provider Business Mailing Address
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Address Line | 2225 ADMIRAL CIR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-1733
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Country | US
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Telephone | 757-722-9961
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORI BANNON
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Credential | ARNP, NP-C
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Telephone | 757-722-9961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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