Organization
DAVENPORT ADULT AND GERIATRIC WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN J DAVENPORT NP (PRESIDENT)
(804) 564-6283
Entity
Organization
Contact information
Practice address
6701 COURTYARD RD, CHESTER, VA 23831-1430
(804) 564-6283
Mailing address
9536 ASHLEYVILLE TURN, MIDLOTHIAN, VA 23112-1690
(804) 564-6283
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024169750
VIRGINIA STATE MEDICAL LICENSE
VA
Enumeration date
04/21/2020
Last updated
04/21/2020
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