Healthcare Provider Details

I. General information

NPI: 1205948965
Provider Name (Legal Business Name): ELIZABETH FLOW NEWBERRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HERITAGE WAY NE SUITE 302
LEESBURG VA
20176-4544
US

IV. Provider business mailing address

102 HERITAGE WAY NE #302
LEESBURG VA
20176-4544
US

V. Phone/Fax

Practice location:
  • Phone: 703-771-5100
  • Fax: 703-777-0170
Mailing address:
  • Phone: 703-737-8527
  • Fax: 703-777-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0001138447
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: