Provider Demographics
NPI:1417592684
Name:MCINTOSH, SONYA JENELLE (CNA, CPR/BLS INSTRU)
Entity Type:Individual
Prefix:MISS
First Name:SONYA
Middle Name:JENELLE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:CNA, CPR/BLS INSTRU
Other - Prefix:MRS
Other - First Name:SONYA
Other - Middle Name:JENELLE
Other - Last Name:FOGG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA, CPR/BLS INSTRUC
Mailing Address - Street 1:1122 SELDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23523-2126
Mailing Address - Country:US
Mailing Address - Phone:757-579-8807
Mailing Address - Fax:
Practice Address - Street 1:1122 SELDEN AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23523-2126
Practice Address - Country:US
Practice Address - Phone:757-579-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide