=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427721372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HALEY MARINO BRIERLEY NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2021
-----------------------------------------------------
Last Update Date | 07/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5215 W BROAD ST
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23230-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-554-5688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4990 SCANDIA RD
-----------------------------------------------------
City | SANDSTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23150-5407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-604-1225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F07211386
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------