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Organization
RETRO MEDICAL LLC
Active
Organization
RETRO MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER L FELLMAN FNP-C (OWNER)
(757) 348-4736
Entity
Organization
Contact information
Practice address
5241 BALBOA DR, VIRGINIA BEACH, VA 23464-2641
(757) 348-4736
(757) 279-7090
Mailing address
5241 BALBOA DR, VIRGINIA BEACH, VA 23464-2641
(757) 348-4736
(757) 279-7090
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024166865
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316982457
INDIVIDUAL NPI FOR DR JENNIFER FELLMAN
VA
Enumeration date
04/27/2014
Last updated
04/27/2014
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