Provider Demographics
NPI:1407012859
Name:PURVEYOR, ATOOSA DEYANAT (DNP)
Entity Type:Individual
Prefix:
First Name:ATOOSA
Middle Name:DEYANAT
Last Name:PURVEYOR
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:ATOOSA
Other - Middle Name:
Other - Last Name:DEYANAT-YAZDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 SENTARA CIR RM 2C
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5713
Practice Address - Country:US
Practice Address - Phone:757-984-7217
Practice Address - Fax:757-984-7210
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167928363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1407012859Medicaid
VAP00670954Medicare PIN
VA018196R53Medicare PIN