Healthcare Provider Details

I. General information

NPI: 1801659826
Provider Name (Legal Business Name): ELIZABETH STANLEY MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 07/03/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13855 COURTHOUSE RD
DINWIDDIE VA
23841-2254
US

IV. Provider business mailing address

1508 KV ROAD
VICTORIA VA
23974-2016
US

V. Phone/Fax

Practice location:
  • Phone: 804-469-3731
  • Fax:
Mailing address:
  • Phone: 804-310-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024189395
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: