Healthcare Provider Details

I. General information

NPI: 1811464688
Provider Name (Legal Business Name): ELIZABETH PAGE FAUBER DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MACTANLY PL
STAUNTON VA
24401-2373
US

IV. Provider business mailing address

PO BOX 8310
ROANOKE VA
24014-0310
US

V. Phone/Fax

Practice location:
  • Phone: 540-932-5850
  • Fax: 540-932-5851
Mailing address:
  • Phone: 540-345-3556
  • Fax: 540-342-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024176772
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number0001214086
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: