1467932673 NPI number — MS. JESSICA LEEANNE WEBB DNP, CRNA

Table of content: MS. JESSICA LEEANNE WEBB DNP, CRNA (NPI 1467932673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467932673 NPI number — MS. JESSICA LEEANNE WEBB DNP, CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBB
Provider First Name:
JESSICA
Provider Middle Name:
LEEANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DNP, CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GALLEGOS
Provider Other First Name:
JESSICA
Provider Other Middle Name:
LEEANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467932673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
134 BUSINESS PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23462-6523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-473-0055
Provider Business Mailing Address Fax Number:
757-473-0075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 GRESHAM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-473-0055
Provider Business Practice Location Address Fax Number:
757-473-0075
Provider Enumeration Date:
08/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  0024176458 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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