Healthcare Provider Details

I. General information

NPI: 1285641738
Provider Name (Legal Business Name): ELIZABETH YVETTE PRICE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MORTON AVE
PETERSBURG VA
23805-2749
US

IV. Provider business mailing address

2806 TRARICH RD
PETERSBURG VA
23805-2615
US

V. Phone/Fax

Practice location:
  • Phone: 804-862-8004
  • Fax: 804-862-6158
Mailing address:
  • Phone: 804-862-8004
  • Fax: 804-862-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0002050868
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: