Provider Demographics
NPI:1922446293
Name:ELLIOTT, ESSENCE CHEVAIR
Entity Type:Individual
Prefix:
First Name:ESSENCE
Middle Name:CHEVAIR
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 HAYGOOD RD STE 4
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5401
Mailing Address - Country:US
Mailing Address - Phone:757-500-0499
Mailing Address - Fax:757-500-4627
Practice Address - Street 1:4620 HAYGOOD RD STE 4
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5401
Practice Address - Country:US
Practice Address - Phone:757-500-4537
Practice Address - Fax:757-500-4627
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X, 374U00000X
VA401155583376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1740783166Medicaid