Individual
TRIVINIA KELLAM HAIRSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
375 BEAVER RIDGE RD, COLLINSVILLE, VA 24078-3073
(276) 547-1585
(276) 647-1585
Mailing address
375 BEAVER RIDGE RD, COLLINSVILLE, VA 24078-3073
(276) 547-1585
(276) 647-1585
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
0001134098
VA
Other
Enumeration date
11/19/2009
Last updated
11/19/2009
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