Healthcare Provider Details

I. General information

NPI: 1639348758
Provider Name (Legal Business Name): ELIZABETH TURNER CANCRO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 LUCY CORR BLVD
CHESTERFIELD VA
23832-6657
US

IV. Provider business mailing address

6800 LUCY CORR BLVD
CHESTERFIELD VA
23832
US

V. Phone/Fax

Practice location:
  • Phone: 804-318-8584
  • Fax: 804-748-5054
Mailing address:
  • Phone: 804-318-8584
  • Fax: 804-748-5054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024078916
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001078916
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: