Provider Demographics
NPI:1376000570
Name:CARRINGTON, WANDA LIZETTE (NP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:LIZETTE
Last Name:CARRINGTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3143 MAGIC HOLLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-3077
Mailing Address - Country:US
Mailing Address - Phone:757-385-8222
Mailing Address - Fax:
Practice Address - Street 1:3143 MAGIC HOLLOW BLVD STE B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-3077
Practice Address - Country:US
Practice Address - Phone:757-385-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-23
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011508363L00000X, 363LP0808X
VA0024180549363LP0808X
NC291100363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner