Provider Demographics
NPI:1942214093
Name:NEVILLE, ANITA
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 THOMAS NELSON HWY
Mailing Address - Street 2:
Mailing Address - City:ARRINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22922-2302
Mailing Address - Country:US
Mailing Address - Phone:434-263-4000
Mailing Address - Fax:
Practice Address - Street 1:4038 THOMAS NELSON HWY
Practice Address - Street 2:
Practice Address - City:ARRINGTON
Practice Address - State:VA
Practice Address - Zip Code:22922-2302
Practice Address - Country:US
Practice Address - Phone:434-263-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183093363LP0200X
NC274421363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000918145LMedicaid
NC1942214093Medicaid
SCNP3822Medicaid
SCNP3822Medicaid
NCNCS189BMedicare PIN
NC1942214093Medicaid
NCNCS189AMedicare PIN
NCNCS189EMedicare PIN