Healthcare Provider Details

I. General information

NPI: 1144075664
Provider Name (Legal Business Name): ELIZABETH MARIE MATHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 ALBERTINE CT
CHESAPEAKE VA
23320-6775
US

IV. Provider business mailing address

706 ALBERTINE CT
CHESAPEAKE VA
23320-6775
US

V. Phone/Fax

Practice location:
  • Phone: 240-585-1940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR248057
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number024190360
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: