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NPI Code Detail

MEDICARE: PETITECHA WIMBUSH PMHNP-BC

MEDICARE:   PETITECHA  WIMBUSH  PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner0024181676VA

General Provider Information

NPI Number : 1285207522
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETITECHA WIMBUSH PMHNP-BC
Provider Business Mailing Address
First Line : 13000 RIVERS BEND BLVD
Second Line :
City : CHESTER
State : VA
Zip : 23836-8632
Country : US
Telephone Number : 804-234-4893
Fax Number : 804-964-3175
Provider Business Practice Location Address
First Line : 13000 RIVERS BEND BLVD
Second Line :
City : CHESTER
State : VA
Zip : 23836-8632
Country : US
Telephone Number : 804-234-4893
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2021
Last Update Date : 06/11/2024

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Directions to “ PETITECHA WIMBUSH PMHNP-BC” Practice Location

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