Basic Information
| Provider Information | |||||||||
| NPI: | 1841840725 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOTICHKA | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | HOFFMAN | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1610 VAN COUVER ST | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226013227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405390802 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1840 AMHERST ST | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405367897 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2019 | ||||||||
| LastUpdateDate: | 09/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WN0002X | 0001249456 | VA | Y | Nursing Service Providers | Registered Nurse | Neonatal Intensive Care |
No ID Information.