MEDICARE: MRS. JULIA ANN MCKINNIS RN

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
1	163WA2000X	Administrator Registered Nurse	0001136083	VA

General Provider Information

NPI Number	:	1740233618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIA ANN MCKINNIS RN

Provider Business Mailing Address
First Line	:	313 VIRGINIA AVE
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-3729
Country	:	US
Telephone Number	:	434-770-8752
Fax Number	:	434-836-3073

Provider Business Practice Location Address
First Line	:	1320 PINEY FOREST RD
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-1606
Country	:	US
Telephone Number	:	434-836-3072
Fax Number	:	434-836-3073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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