Provider Demographics
NPI:1164770087
Name:NAVE, MARIE B (PA)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:B
Last Name:NAVE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:BERSAMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 COLISEUM DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5963
Mailing Address - Country:US
Mailing Address - Phone:757-736-7280
Mailing Address - Fax:757-224-3541
Practice Address - Street 1:3000 COLISEUM DR
Practice Address - Street 2:STE. 200
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5963
Practice Address - Country:US
Practice Address - Phone:757-736-7280
Practice Address - Fax:757-224-3541
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001181285163W00000X
VA0110003991363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC02033OtherMEDICARE GROUP NUMBER