=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588117691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BE NICE NORFLEET
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2016
-----------------------------------------------------
Last Update Date | 07/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 323 PEFLEY DR
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23502-5255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-359-2585
-----------------------------------------------------
Fax | 757-466-2898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 323 PEFLEY DR
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23502-5255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-359-2585
-----------------------------------------------------
Fax | 757-466-2898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MS. SHELICA NORFLEET
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-359-2585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 343900000
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------