=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598579807
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAYA NICHOLSON WHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2025
-----------------------------------------------------
Last Update Date | 08/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7300 ASHLAKE PKWY STE 200
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23832-2827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-256-8282
-----------------------------------------------------
Fax | 804-256-8288
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12409 POMFRET CT
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23114-3228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-350-4423
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 24192401
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------