=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285342493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PIONEER FAMILY MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2022
-----------------------------------------------------
Last Update Date | 01/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1768 E MAIN ST
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24266-3438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-883-5455
-----------------------------------------------------
Fax | 276-883-9208
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3327 SUNSET DR
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24283-3713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-883-5455
-----------------------------------------------------
Fax | 276-883-9208
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VIRGINIA CAROLINE BOARDWINE
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 276-883-5455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------