Provider Demographics
NPI:1831968585
Name:NEBLETT, MAURICE
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:NEBLETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25392
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23260-5392
Mailing Address - Country:US
Mailing Address - Phone:804-298-4292
Mailing Address - Fax:804-988-5213
Practice Address - Street 1:521 N. ADAMS ST, STE 30
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220
Practice Address - Country:US
Practice Address - Phone:804-335-8625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001304164163WH0200X
251S00000X, 253Z00000X, 314000000X, 261QR0208X, 313M00000X, 251E00000X, 320900000X, 342000000X, 372600000X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No342000000XTransportation ServicesTransportation Network Company
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide