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General NPI Number Information
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NPI Number | 1790563252
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Entity Type | Organization
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Legal Business Name | ALIVE HEALTH & WELLNESS
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 6804 WOODLAKE COMMONS LOOP
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2281
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Country | US
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Telephone | 804-636-3918
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Fax | 804-331-6173
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Provider Business Mailing Address
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Address Line | 6804 WOODLAKE COMMONS LOOP
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2281
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Country | US
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Telephone | 804-636-3918
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Fax | 804-331-6173
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | JENEA BENNETT-TALLEY
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Credential | APRN, DNP, FNP-C
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Telephone | 804-636-3918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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