Healthcare Provider Details

I. General information

NPI: 1124137120
Provider Name (Legal Business Name): ERIN ICENBICE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BATTLEFIELD BLVD N CHESAPEAKE GENERAL HOSPITAL
CHESAPEAKE VA
23320-4941
US

IV. Provider business mailing address

4536 BONNEY RD
VIRGINIA BEACH VA
23462-3869
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-9388
  • Fax: 757-490-9401
Mailing address:
  • Phone: 757-490-9388
  • Fax: 757-490-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110001733
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: