Provider Demographics
NPI:1750894945
Name:PODESTA, CATHERINE MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MICHELLE
Last Name:PODESTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:MICHELLE
Other - Last Name:TILLERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1060 FIRST COLONIAL RD FL 1
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3002
Mailing Address - Country:US
Mailing Address - Phone:757-395-6116
Mailing Address - Fax:757-395-1339
Practice Address - Street 1:1060 FIRST COLONIAL RD FL 1
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3002
Practice Address - Country:US
Practice Address - Phone:757-395-6116
Practice Address - Fax:757-395-1339
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001185554163W00000X
VA0024175642363L00000X, 363LA2200X, 363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology