Provider Demographics
NPI:1124574777
Name:BOARDWINE, VIRGINIA CAROLINE (NP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:CAROLINE
Last Name:BOARDWINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24263-1215
Mailing Address - Country:US
Mailing Address - Phone:276-546-5310
Mailing Address - Fax:
Practice Address - Street 1:1389 DANTE ROAD
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:VA
Practice Address - Zip Code:24283-3658
Practice Address - Country:US
Practice Address - Phone:276-467-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily