Healthcare Provider Details

I. General information

NPI: 1972773018
Provider Name (Legal Business Name): NATASHA M CRICHLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 JEFFERSON AVE
FORT EUSTIS VA
23604
US

IV. Provider business mailing address

PO BOX 4529
FORT EUSTIS VA
23604-0529
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-4084
  • Fax:
Mailing address:
  • Phone: 757-358-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: