Healthcare Provider Details

I. General information

NPI: 1215994819
Provider Name (Legal Business Name): ELIZABETH ANN SCHLECK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 204
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR STE 204
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-5680
  • Fax: 757-388-5681
Mailing address:
  • Phone: 757-388-5680
  • Fax: 757-388-5681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024090302
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024090302
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: