Provider Demographics
NPI:1316102577
Name:NATION, PETE-GAYE V
Entity type:Individual
Prefix:
First Name:PETE-GAYE
Middle Name:V
Last Name:NATION
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5915
Mailing Address - Fax:757-446-5089
Practice Address - Street 1:721 FAIRFAX AVE FL 3
Practice Address - Street 2:EVMS PMR DEPARTMNET
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-2007
Practice Address - Country:US
Practice Address - Phone:757-446-5915
Practice Address - Fax:757-446-5089
Is Sole Proprietor?:No
Enumeration Date:2008-07-26
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247493208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA409486OtherANTHEM BC/BS
VA10064688OtherOPTIMA HEALTH
VAPAROtherVIRGINIA PREMIER HEALTH PLAN
NC5915479Medicaid
VAPAROtherCIGNA
VAPAROtherUSA MANAGED CARE
VA-017OtherTRICARE/CHAMPUS
VAPAROtherCORVEL/CORCARE
VAPAROtherFIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH
VAPAROtherMULTIPLAN
VA1316102577Medicaid
VAPAROtherAETNA
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherUNITED HEALTH CARE/MAMSI
NC5915479Medicaid