MEDICARE: HEIDI NICOLE CRITCHFIELD NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	0024188395	VA

General Provider Information

NPI Number	:	1710769138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI NICOLE CRITCHFIELD NP

Provider Business Mailing Address
First Line	:	4444 GERMANNA HWY STE 310
Second Line	:
City	:	LOCUST GROVE
State	:	VA
Zip	:	22508-2039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4444 GERMANNA HWY STE 310
Second Line	:
City	:	LOCUST GROVE
State	:	VA
Zip	:	22508-2039
Country	:	US
Telephone Number	:	540-972-6222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2023
Last Update Date	:	10/19/2023

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