Provider Demographics
NPI:1619935061
Name:MAIDEN, ELIZABETH JANE (FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:MAIDEN
Suffix:
Gender:F
Credentials:FNP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7202 GLEN FOREST DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3781
Mailing Address - Country:US
Mailing Address - Phone:804-673-2024
Mailing Address - Fax:804-673-1796
Practice Address - Street 1:1401 JOHNSTON WILLIS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4730
Practice Address - Country:US
Practice Address - Phone:804-330-7990
Practice Address - Fax:804-330-3541
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024164124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC01120OtherMEDICARE GROUP PTAN