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General NPI Number Information
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NPI Number | 1568875235
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Entity Type | Organization
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Legal Business Name | C3 NEXUS LLC
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 737 N 5TH ST SUITE 500
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City | RICHMOND
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State | VA
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Zip | 23219-1441
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Country | US
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Telephone | 804-325-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 737 N 5TH ST SUITE 500
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City | RICHMOND
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State | VA
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Zip | 23219-1441
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Country | US
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Telephone | 804-325-1122
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TONYA MALLORY
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Credential |
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Telephone | 804-325-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SC2300X
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Taxonomy Name | Chronic Care Clinical Nurse Specialist
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License Number | 0101045588
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QR0404X
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Taxonomy Name | Cardiac Rehabilitation Clinic/Center
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License Number | 0101045588
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License Number State | VA
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