Provider Demographics
NPI:1174001366
Name:HANABURY, SYDNEY ROCKWELL (NP-C)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ROCKWELL
Last Name:HANABURY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11271 NUCKOLS RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5502
Mailing Address - Country:US
Mailing Address - Phone:202-251-3975
Mailing Address - Fax:
Practice Address - Street 1:11271 NUCKOLS RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5502
Practice Address - Country:US
Practice Address - Phone:202-251-3975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily