Provider Demographics
NPI:1912570078
Name:BASS, ALINE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:ALINE
Middle Name:MARIE
Last Name:BASS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-437-0411
Mailing Address - Fax:757-552-0378
Practice Address - Street 1:1728 VIRGINIA BEACH BLVD STE 113
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4533
Practice Address - Country:US
Practice Address - Phone:757-437-0411
Practice Address - Fax:757-552-0378
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002095397164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0002095397OtherLPN