Healthcare Provider Details

I. General information

NPI: 1063882355
Provider Name (Legal Business Name): ELIZABETH PETERS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 LOCKWOOD DR
CHARLOTTESVILLE VA
22911-5614
US

IV. Provider business mailing address

PO BOX 31494
HENRICO VA
23294-1494
US

V. Phone/Fax

Practice location:
  • Phone: 434-981-0614
  • Fax: 804-282-9135
Mailing address:
  • Phone: 434-981-0614
  • Fax: 804-282-9135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172986
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: