Provider Demographics
NPI:1255643920
Name:WIRTH, ELIZABETH L (RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:WIRTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9210 ARBORETUM PKWY
Mailing Address - Street 2:260
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3472
Mailing Address - Country:US
Mailing Address - Phone:804-915-4602
Mailing Address - Fax:804-327-8496
Practice Address - Street 1:8266 ATLEE RD
Practice Address - Street 2:133
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1804
Practice Address - Country:US
Practice Address - Phone:804-730-2121
Practice Address - Fax:804-730-0563
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001223988163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse