Individual
MRS. TERESA ANN SHIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN
Contact information
Practice address
8850 RICHMOND HWY STE 202, ALEXANDRIA, VA 22309-1586
(703) 704-7004
Mailing address
1649 HUNTING CREEK DR, ALEXANDRIA, VA 22314-6219
(703) 704-6199
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
0001149341
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001149341
NURSING LICENSE
VA
Enumeration date
08/24/2006
Last updated
07/08/2007
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