Healthcare Provider Details

I. General information

NPI: 1467183541
Provider Name (Legal Business Name): NICOLA ELIZABETH LITCHFIELD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 MEMORIAL AVE STE 10
LYNCHBURG VA
24501-2652
US

IV. Provider business mailing address

2323 MEMORIAL AVE STE 10
LYNCHBURG VA
24501-2652
US

V. Phone/Fax

Practice location:
  • Phone: 143-420-0615
  • Fax:
Mailing address:
  • Phone: 143-420-0615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116036753
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: