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General NPI Number Information
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NPI Number | 1366715112
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Entity Type | Individual
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Provider Name | MARY G. CRUTCHFIELD PMHNP, FNP
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Gender | Female
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 11/30/2025
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Provider Practice Location Address
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Address Line | 4445 CORPORATION LN STE 110
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3264
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Country | US
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Telephone | 757-453-5508
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Fax | 757-216-9655
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Provider Business Mailing Address
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Address Line | 4445 CORPORATION LN STE 110
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3264
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Country | US
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Telephone | 757-453-5508
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Fax | 757-216-9655
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024169848
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License Number State | VA
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