Provider Demographics
NPI:1861770323
Name:DUEY, KATHERINE CHURCH
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CHURCH
Last Name:DUEY
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 1:1181 FIRST COLONIAL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2437
Mailing Address - Country:US
Mailing Address - Phone:757-496-5370
Mailing Address - Fax:757-481-3354
Practice Address - Street 1:1181 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2437
Practice Address - Country:US
Practice Address - Phone:757-496-5370
Practice Address - Fax:757-481-3354
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169454363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0017140206OtherLICENSE