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General NPI Number Information
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NPI Number | 1982379590
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Entity Type | Organization
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Legal Business Name | PREMIUM HEALTHCARE LLC
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 05/14/2026
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Provider Practice Location Address
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Address Line | 8000 TOWERS CRESCENT DR STE 1352
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City | VIENNA
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State | VA
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Zip | 22182-6207
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Country | US
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Telephone | 251-901-3011
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Fax | 251-901-3011
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Provider Business Mailing Address
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Address Line | PO BOX 8209
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City | VIENNA
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State | VA
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Zip | 22183-2058
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Country | US
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Telephone | 251-901-3011
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Fax | 251-901-3011
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Authorized Official
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Title or Position | AUTHORIZED MEMBER
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Name | SYED NAQVI
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Credential |
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Telephone | 251-901-3011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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