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General NPI Number Information
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NPI Number | 1588525935
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Entity Type | Organization
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Legal Business Name | DAVITA MEDICAL HOME LLC
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 962 NORFOLK SQ
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City | NORFOLK
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State | VA
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Zip | 23502-3235
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Country | US
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Telephone | 757-461-0501
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 16TH ST
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City | DENVER
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State | CO
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Zip | 80202-5117
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP, LICENSURE & CERTIFICATION
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Name | SAMUEL T WEY
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Credential |
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Telephone | 615-341-6641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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