Individual
NATHAN IAN DALLEAVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1243 LANIER RD, MARTINSVILLE, VA 24112-5211
(336) 437-5392
Mailing address
1243 LANIER RD, MARTINSVILLE, VA 24112-5211
(336) 437-5392
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
03479
NC
Other
Enumeration date
10/21/2016
Last updated
10/21/2016
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