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General NPI Number Information
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NPI Number | 1548819014
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Entity Type | Organization
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Legal Business Name | GREENBRIER HEALTH AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/08/2019
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 1226 PROGRESSIVE DR STE 101
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2847
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Country | US
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Telephone | 757-609-3301
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Fax |
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Provider Business Mailing Address
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Address Line | 1226 PROGRESSIVE DR STE 101
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2847
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Country | US
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Telephone | 757-609-3301
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIBELLE M BLACKMON
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Credential | NP-C
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Telephone | 757-609-3301
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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 |
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License Number State |
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