Provider Demographics
NPI:1356501423
Name:CROCKER, VIRGINIA (GNP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:CROCKER
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:POWELLSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27967-0040
Mailing Address - Country:US
Mailing Address - Phone:252-332-6484
Mailing Address - Fax:
Practice Address - Street 1:105 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:POWELLSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27967
Practice Address - Country:US
Practice Address - Phone:252-332-6484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600104363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology