Provider Demographics
NPI:1821580770
Name:MIDYETTE, JEAN GILBERT (MSN, MSA, RN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:GILBERT
Last Name:MIDYETTE
Suffix:
Gender:F
Credentials:MSN, MSA, RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 COLISEUM DR STE 420
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5904
Mailing Address - Country:US
Mailing Address - Phone:757-827-2084
Mailing Address - Fax:757-827-2173
Practice Address - Street 1:4000 COLISEUM DR STE 420
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5904
Practice Address - Country:US
Practice Address - Phone:757-827-2084
Practice Address - Fax:757-827-2173
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001070200163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse