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General NPI Number Information
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NPI Number | 1760781447
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Entity Type | Organization
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Legal Business Name | SHAVONTE'S PERSONAL TOUCH NURSING SERVICES LLC
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 3303 E BROAD ROCK RD
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City | RICHMOND
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State | VA
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Zip | 23224-3503
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Country | US
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Telephone | 804-833-4655
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Fax |
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Provider Business Mailing Address
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Address Line | 3303 E BROAD ROCK ROAD
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City | RICHMOND
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State | VA
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Zip | 23224
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Country | US
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Telephone | 804-833-4655
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | SHAVONTE DANIELLE CHESTNUT
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Credential | L.P.N
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Telephone | 804-833-4655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 0002075539
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License Number State | VA
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