Healthcare Provider Details

I. General information

NPI: 1437814068
Provider Name (Legal Business Name): ELI CRISLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 W MAIN ST
WAYNESBORO VA
22980-1600
US

IV. Provider business mailing address

1647 MULBERRY AVE
CHARLOTTESVILLE VA
22903-3705
US

V. Phone/Fax

Practice location:
  • Phone: 540-221-6702
  • Fax:
Mailing address:
  • Phone: 434-490-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number0024183073
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024183073
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: