Provider Demographics
NPI:1063942522
Name:STREETER, VIRGINIA NICOLE (PA)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:NICOLE
Last Name:STREETER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:NICOLE
Other - Last Name:KINSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:624 BLOSSOM ARCH
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-6688
Mailing Address - Country:US
Mailing Address - Phone:540-935-9024
Mailing Address - Fax:
Practice Address - Street 1:5544 GREENWICH RD STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6563
Practice Address - Country:US
Practice Address - Phone:757-466-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant