Provider Demographics
NPI:1639862865
Name:ORR, ELISSA NICOLE (CPM, LM)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:NICOLE
Last Name:ORR
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2584 ROBINHOOD RD
Mailing Address - Street 2:
Mailing Address - City:CALLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24530-3548
Mailing Address - Country:US
Mailing Address - Phone:434-688-6207
Mailing Address - Fax:
Practice Address - Street 1:2584 ROBINHOOD RD
Practice Address - Street 2:
Practice Address - City:CALLANDS
Practice Address - State:VA
Practice Address - Zip Code:24530-3548
Practice Address - Country:US
Practice Address - Phone:434-688-6207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000186176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife