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General NPI Number Information
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NPI Number | 1225566979
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Entity Type | Individual
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Provider Name | CHARESE NESBITT LPN
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Gender | Female
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 05/25/2017
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Provider Practice Location Address
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Address Line | 14121 PARKE LONG CT STE 201
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City | CHANTILLY
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State | VA
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Zip | 20151-1647
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Country | US
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Telephone | 855-247-1940
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 HORNE AVE
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City | PORTSMOUTH
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State | VA
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Zip | 23701-3911
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Country | US
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Telephone | 757-383-1800
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 0002072777
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License Number State | VA
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