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General NPI Number Information
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NPI Number | 1508286725
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Entity Type | Organization
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Legal Business Name | RETRO MEDICAL LLC
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Dates
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Enumeration Date | 04/27/2014
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Last Update Date | 04/27/2014
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Provider Practice Location Address
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Address Line | 5241 BALBOA DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-2641
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Country | US
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Telephone | 757-348-4736
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Fax | 757-279-7090
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Provider Business Mailing Address
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Address Line | 5241 BALBOA DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-2641
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Country | US
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Telephone | 757-348-4736
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Fax | 757-279-7090
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER L FELLMAN
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Credential | FNP-C
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Telephone | 757-348-4736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024166865
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License Number State | VA
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