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General NPI Number Information
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NPI Number | 1962022392
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Entity Type | Organization
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Legal Business Name | GLADEVIEW MEDICAL LLC
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 279 GLADEVIEW DR
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City | FRIES
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State | VA
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Zip | 24330-3936
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Country | US
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Telephone | 276-233-7864
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Fax |
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Provider Business Mailing Address
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Address Line | 279 GLADEVIEW DR
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City | FRIES
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State | VA
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Zip | 24330-3936
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Country | US
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Telephone | 276-233-7864
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER/OWNER
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Name | HEATHER RICHARDSON
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Credential | FNP-BC
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Telephone | 276-233-7864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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