Provider Demographics
NPI:1073116992
Name:CURTIS, CECELIA KATHLEEN (MPA, PA-C)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:KATHLEEN
Last Name:CURTIS
Suffix:
Gender:F
Credentials:MPA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W BRAMBLETON AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1115
Mailing Address - Country:US
Mailing Address - Phone:757-624-6220
Mailing Address - Fax:757-627-0200
Practice Address - Street 1:400 W BRAMBLETON AVE STE 100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1115
Practice Address - Country:US
Practice Address - Phone:757-627-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110007963363A00000X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program