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General NPI Number Information
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NPI Number | 1841742384
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Entity Type | Individual
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Provider Name | KASHA DENNA FADOUL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 135 HALL AVE
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City | SUFFOLK
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State | VA
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Zip | 23434-4657
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Country | US
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Telephone | 757-514-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 135 HALL AVE
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City | SUFFOLK
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State | VA
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Zip | 23434-4657
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Country | US
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Telephone | 757-514-4700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001276705
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 81858
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN81858-FNP-BC
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License Number State | WV
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024175624
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License Number State | VA
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