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General NPI Number Information
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NPI Number | 1851065676
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Entity Type | Organization
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Legal Business Name | VIRGINIA BEACH KETAMINE & WELLNESS
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 1856 COLONIAL MEDICAL CT STE D
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3075
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Country | US
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Telephone | 757-751-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 1856 COLONIAL MEDICAL CT STE D
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3075
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Country | US
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Telephone | 757-751-0800
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | TRICIA LEE
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Credential | CRNA, NP
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Telephone | 757-412-7030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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