Basic Information
| Provider Information | |||||||||
| NPI: | 1558875393 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | RESHMA | ||||||||
| MiddleName: | SUTHAR | ||||||||
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| Credential: | MSN, RN, CPNP-AC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 607 CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | ABINGDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242109700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2765754603 | ||||||||
| FaxNumber: | 2765254608 | ||||||||
| Practice Location | |||||||||
| Address1: | 607 CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | ABINGDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242109700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2765754603 | ||||||||
| FaxNumber: | 2765254608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2017 | ||||||||
| LastUpdateDate: | 06/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0222X | 9475916 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics, Critical Care | 390200000X | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363LP0200X | 0024177593 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.