Provider Demographics
NPI:1295359883
Name:ADVANCED ONSITE CARE LLC
Entity Type:Organization
Organization Name:ADVANCED ONSITE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEMEKA
Authorized Official - Middle Name:SHAVONNE
Authorized Official - Last Name:HATHAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:757-513-9282
Mailing Address - Street 1:1045 ROBERT WELCH LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-6770
Mailing Address - Country:US
Mailing Address - Phone:757-513-9282
Mailing Address - Fax:
Practice Address - Street 1:1045 ROBERT WELCH LN
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-6770
Practice Address - Country:US
Practice Address - Phone:757-513-9282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-30
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care