Healthcare Provider Details

I. General information

NPI: 1629337423
Provider Name (Legal Business Name): ELIZABETH ELLEN LARKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BLVD
SALEM VA
24153-6478
US

IV. Provider business mailing address

1970 ROANOKE BLVD
SALEM VA
24153-6478
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2463
  • Fax: 540-855-3469
Mailing address:
  • Phone: 540-982-2463
  • Fax: 540-855-3469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number986572
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: