Healthcare Provider Details

I. General information

NPI: 1639386683
Provider Name (Legal Business Name): DIANNE ELIZABETH ELLIOTT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOLBROOK ST
DANVILLE VA
24541-1732
US

IV. Provider business mailing address

130 MANCHESTER AVE.
DANVILLE VA
24541
US

V. Phone/Fax

Practice location:
  • Phone: 434-792-4041
  • Fax: 434-792-0124
Mailing address:
  • Phone: 434-793-9317
  • Fax: 434-792-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024066200
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024066200
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: