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General NPI Number Information
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NPI Number | 1609446269
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Entity Type | Individual
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Provider Name | MARY ELLER FNP
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Gender | Female
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 05/20/2022
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Provider Practice Location Address
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Address Line | 4207 GERMANNA HWY STE E
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City | LOCUST GROVE
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State | VA
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Zip | 22508-2040
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Country | US
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Telephone | 540-726-5659
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Fax |
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Provider Business Mailing Address
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Address Line | 15521 REAL ESTATE AVE STE 206
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City | KING GEORGE
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State | VA
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Zip | 22485-5328
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024181712
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License Number State | VA
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