MEDICARE: MR. MICHAEL DAVID NP

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	163WN0300X	Nephrology Registered Nurse	0001207279	VA
2	363LF0000X	Family Nurse Practitioner	0024186763	VA

General Provider Information

NPI Number	:	1881318699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL DAVID NP

Provider Business Mailing Address
First Line	:	6160 KEMPSVILLE CIR STE 302A
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-3936
Country	:	US
Telephone Number	:	757-466-9288
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 THREE GAIT TRL
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-2501
Country	:	US
Telephone Number	:	757-214-5068
Fax Number	:

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

Provider Enumeration Date	:	09/27/2022
Last Update Date	:	03/22/2023

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